Chapter 319 - A few Notes

I think we are both sleeping better since the decision was made not to travel to Pivot City for the wedding. She was afraid of the difficulties to be faced, myself how to help her and minimise her pain and stress. She is waking me less frequently for assistance onto the commode. Early in the week I reverted to positioning our "foldable" commode, without wheels, beside the bed so that she needed less assistance to sit upon it. The replacement chair from the Hospital OT, exchanged for the first one which developed wheel locking problems, is too high for her, for when seated her feet do not touch the floor and often she needed me to lift under her left arm. In consequence, my left fore arm now has pains in it. Fortunately, for a period of several weeks, she is able to walk, well shuffle really, into the bathroom to shower, seated on our shower chair. I rang the Hospital OT about the height of the commode only to learn that she is no longer in the job, but she said she would arrange for someone to visit to check the height of the commode. It seems the first one we had was a low one, most are taller. No mention of the commode "ordered" for us. And no one has phoned or called yet to check their commode. Perhaps we will have to buy our own wheeled commode/shower chair and to hell with assistance.

Tuesday before last one of the Respite staff mentioned to me that she was in difficulties during the day and that the "new" medication was not having much effect. Next day at home she commented that the night and day following each Tuesday Respite were "bad" for her. I noticed the same after Respite this week.

Yesterday she unilaterally decided to reduce the Motilium anti-nausea pills from 3x two to 3x one each day. She has not suffered any nausea feelings.

She has noticed that within seconds of administering a bolus of Apomine that her toes tingle. After a bolus at 4:45am this morning when she woke very stiff and uncomfortable her leg tremors/shakes were undiminished bringing her to the conclusion that the bolus dose had not helped her at all. She also experiences the "someone walked over my grave" feelings (that we now refer to as "myoclonus" rightly or wrongly) following bolus doses. While seated on the commode following this morning's 6am meds, she reported that when her feet were on the floor rather than a pillow, that her insides were "churned up" although she felt better with  her heals pressed hard into the floor but then in attempting to return to bed her toes insisted in turning down.

She slept in this morning so the Apomine pump was only started after a shower at the time of her 10am meds. She reported toe tingling before the pump started and afterwards  tight bands around her feet. Walking and using the pedals also initiates foot and toe tingles.

Yesterday she commented that her right foot/leg was deteriorating and behaving much like her left.

From last Tuesday's respite she brought home an unassembled doll that had been donated. Since then she has spent 3 to 4 hours each day putting it together and making clothing for it. Several times she has commented that she had assembled pieces of clothing in reverse order or her hands have been unable to manipulate pins.

I re-subscribed her to Lumosity brain training and she has had several sessions without needing to be prompted.

A few days ago from a PD Forum I learnt of an exercise regime specifically for Parkies, and was surprised to find accredited physios in this country, one of which is quite close to the Hot Air City Hospital. So I sent them an email requesting an appointment. Having found YouTube demmos of the techniques I decided that due to balance problems such exercise is best introduced by a professional.

Hopefully the Revolutionary Chair we ordered will be available by next Thursday when next we visit Hot Air City to see Polly the PD nurse, and perhaps the physio at the same time.

Chapter 318 - Disappointed Yet Relieved

In different circumstances we should be on our way south for the wedding. With much anguish I opted out of attending and then cancelled the motel reservation. Then I felt relief, having not realised how much stress I had been under vacillating between the thoughts of causing her pain and distress and  disappointing the family. Then I was told by someone close that "it was all in her mind" and that we should attend the wedding (note that at our rate of travel these days plus late starts and early finishes, the trip lasts 2 days each way). Many years ago a retired nurse, sitting with her during a panic attack phase while I did some supermarket shopping, also said the same thing "it's all in her mind". On that first occasion I made no comment; this time I stated that it was not her decision not to attend, but mine. Then later I wrote the following (edited) email while in a cool and considered mind.

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[Her] "imagination" had nothing to do with my deciding not to attend [Granddaughter's] wedding. My decision had all to do with her medical conditions due to her Parkinsons and its medications. She is now in her 22nd year of a slowly deteriorating condition and can be described as the disease's end stage (literature usually says this occurs by year 12), when the standard medications tend not to be effective and there is a fine balance between being over or under medicated; over medicated producing painful, disabling symptoms and under medicated producing immobility. Continuous infusion of Apomine is an attempt to stabilise her symptoms; so far this drug has not been very effective and of itself it produces other complications.

Posture - inability to stand upright, compounded by some deterioration in several vertebrae.
Gait - unable to stride normally, mostly shuffles while pushing a walker either inside or outside the house.
Mobility - most often unable to stand without assistance, her legs are not free to move, her hands and fingers become too stiff to handle craft objects, difficulty doing up buttons. Usually she is unable to rise from the toilet and pull up her clothing. In recent months, while walking with her walker, she loses tone in the muscles of her left leg, which tends to collapse beneath her weight and she has almost fallen but has been save by grabbing me or other objects. She has difficulty going up and down steps and fears doing so, especially if there are no railings.
Freezing - Unable to initiate or continue motion when walking, unable to "tell" her feet to move or step, unable to move toes etc of her feet to maintain balance (this frightens the hell out of her).
Stiffness - inability to move arms and legs easily. I believe this contributes to her inability to wipe herself well after a bowel motion, tending to cause thrush and urinary tract infections which are minimised by her toilet at home being fitted with a bidet.
Nocturia - needing to empty her bladder up to 6 times each night, usually needing assistance to sit on the commode in the bedroom.
Dyskinesia - uncontrolled painful movements (in her case legs and feet) causing cramping in leg muscles usually due to peak dose levels of L-dopa, but [she] seems to also suffer diphasic dyskinesia that occurs when serum levels of L-dopa begin to rise and again as L-dopa serum levels decrease to near zero in the 4 hour cycles of her conventional medications (Apomine infusion has not eliminated the "conventional" medications) so in any one 4 hour cycle she may experience three dyskinetic periods depending on medications which are not the same at each 4 hourly dose.
Peripheral Neuropathy -  weird tingling sensations in feet and legs, numbness in feet ( causes difficulty in "knowing" where her feet are, sense of swelling in feet (not observable in a physical sense).
Myoclonus - a weird "shudder" she senses across her shoulders and up into her head. This happens most frequently as she is dropping off to sleep, causing great difficulty in falling asleep, which together with the nocturia, makes for a very poor night of sleep. Over the years she has attempted to describe this sensation as "someone walking over my grave", a comment that I and others have tended to dismiss as nothing more than a quaint colloquialism.
Spatial Orientation - she has difficulty sensing relative distances between objects, whether surfaces are level, fears walking on a sloping path, fears stepping across a gap (for instance between a railway carriage and platform).
Claustrophobia and Agoraphobia - she fears restricted spaces (such as the toilet rooms in many houses, many built without the need of a walker or an accompanying  carer in mind and confined spaces such as building lifts), cluttered areas where obstacles may impede her movements, and, to a lesser degree, wide open spaces without objects to grasp or sit upon.

My descriptions above are my layman's interpretations; Google and Wiki will clarify.

So your comment that "it's all in her mind" is true in a sense, since in her "mind" does she perceives her environment, senses pain and initiates and maintains activity but in the way you intended was hurtful and wrong. Parkinsons is a debilitating chronic condition with no cure, medications only alleviate symptoms for which the price is other compounding difficulties.

[.......]

So, no, we are not attending [Granddaughter's] wedding simply because I decided, all by myself, that a 2 day trip each way and several days in [Pivot City], with nights spent in motels of varying degrees of hospitality for those with a disability, was more than [she] should tolerate. I contemplated attending by myself while placing her in Respite (for which we have gained approval and assistance for up to 65 days per year), or called upon relatives to stay with her in my absence, but I decided that I cannot desert her to either hospital-like conditions or to others inappropriate to help her with private matters. Her use of the Apomine infusion pump in either situation was of no concern since the palliative care nurses are able to call to attend to attend to that each day. Obviously, temporarily staying in a relative's house in [Big Smoke] is completely out of the question.

Our recent Golden Wedding Anniversary reminded us that vows made, so easily broken in many cases, were to look after one another, come what may. We are doing our utmost; other issues are subsidiary.

And shit happens.

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So, please, when referring to the behaviour and emotional state of a PWP never ever say "it's all in the mind" (for that matter, when referring to anyone with a neurological disability). For if it's not of and in the mind then we are not human.

Yet what the above has alerted me to is our unpreparedness for what must surely happen within the coming decade (sounds so much longer than 10 years) when we have both exceeded our "use by dates", We may have wills, powers-of-attorney and ACAT assessments for respite in place, a reasonable asset backing but how in hell do we prepare for the personal, emotional and practical matters when one of us dies? Two scenarios, neither of which one wishes to contemplate.

Not much has changed otherwise. Last week we made the short trip to Hot Air City where we bought an "over the bed" table, on wheels, of the type used in hospitals, a better type of bed pole and ordered a Revolutionary Chair, an expensive chair on which the seat is able to rotate +/- 90 degrees as well as forward by some 100 or so millimetres for use at a table or desk, because she is frequently trapped. frozen, facing the kitchen table or her desk and I need to drag the chair on which she is seated across the floor in order to rescue her - not good for me or the furniture. I may buy a second should the first be successful.

One morning when the Apomine infusion needle was removed there was quite a blood flow, requiring a small round plaster to stop the flow. Days later there is quite extensive bruising around the site. She often reports that on initiating an Apomine bolus dose the big toe on her left foot "tingles"; she yelped in surprise the first time this happened. And if I have her do the Parky finger-to-thumb touching exercise the top of her head tingles and/or itches. The itchy areas on her arms and legs have disappeared, leaving only small scabby bits where the skin had broken. An area on the back of her neck also began to itch and was irritated by the cord supporting the Apomine pump bag but that has almost cleared.

Even though she adjusts the height of the bed at times during the night, there remain a mountain of pillows around her bed and sometimes I wake to find her upside down on the bed.

Some nights she may need the commode only twice, usually more frequently. For instance, this morning between 4am and 5.30am she used the commode 5 times. I must contact the OT at the hospital because the replacement commode is too high, her feet don't touch the floor when seated, and sometimes helping her on and off is a strain.

She found the word "Myoclonus" in one of her PD books; a word and description she over-looked in the past. We are so pleased to have a word to describe the feeling when speaking to learned professionals. Similar to the word "diphasic" mentioned by Polly the PD nurse. A misguided sense of achievement perhaps?

Chapter 317 - Fifty Years On

Fifty years ago today we woke up together in bed in a motel, young innocents 23 and 21 years of age, in a motel patronised by Saturday newly weds in a northern suburb of Big Smoke City on our way further north to a smelly fishing village (in those days) for our honey moon. On our way through Steel City we made use of the mattress on the floor of the bedroom of the small timber house we were to return to, and have two kids, before moving on 10 years later. We also called on the neighbours to introduce her. Two weeks into our honeymoon we grew restive, wishing to furnish the house, although she has always said the weather had been bad, rainy too often, although I have no recollection of wet weather. We returned to our home on November 22nd and woke the following morning to the news that Kennedy had been shot. Our first child was born on November 21st the following year, not quite in sync with world events. My birthday falls on September 11th or 9/11 (as the Yanks say it) and we were married on 9/11 (as we say it). Being a sentimental bloke, I had hoped we might have returned to our honeymoon village this weekend but that was not to be.

Last night I woke around 1am, weeping a little as I reminisced, debating with myself whether I should take her down to Pivot City for the marriage of our eldest grand daughter, who I have told we will be there although we may skip the reception. Some weeks ago we booked a motel we had stayed at the last time we visited the city and we have bought some clothes for the occasion.

When we woke this morning I suggested we not go to the wedding. She was immediately afraid that I will blame her for our non-attendance. But never, never such blame. Our vows to each other 50 years ago included no conditional escape clauses; we stay together, hardly ever being separated, except on a few occasions when illness or work commitments intervened. Especially now, 22 years into her PD sentence, entering what some will call the "end stage" and whatever that may imply (Google it yourself). We have an option of respite for which we have been assessed and we are able to pay anyway for short periods of care. Yet we fear such arrangements, especially at night, when she may require to use the toilet or commode anywhere between two and six times between, say, 10pm and 8am the following morning. At these times she is usually unable to get out of bed by herself, requiring her legs to be lifted over the side of the bed, followed by raising her trunk for her to sit on the edge of the bed, before we lock our left arms, lift her and swing her 90 degrees onto the commode, at the same time lifting her nightie out of the way. Once she used to wear incontinence pants to bed, but such  are a nuisance for commode transfers. She has had only one "accident", and that recently, and possibly the fear of this plays upon her mind to wake her frequently to empty her bladder. One night recently I measured the quantities she voided; the smallest was only 75ml. Childhood training by her parents probably left emotional scars as well to compound any PD complications. To do a "business" (as we call such activity) she always uses the loo, except once recently, when a small accident occurred on the commode. "Businesses" are for the loo with bidet and the fireman's pole on front. To date I have not been required to do any paper wiping actions; she is more than happy to rely on the bidet.

Of course, such toilet attachments are not found in motels or the homes of friends and relatives, and her awkwardness in that area discourages her from staying away from home too long. And toilet bowls positioned at the end of a narrow, one person wide corridor make assistance by a carer impossible as well as ignoring the need to take a walker in as well as no hand holds other than door knobs, hand basins and taps to be stressed while attempting to haul herself up onto her feet.

Often she calls me on the CB for assistance to pull her inner and outer pants up after she has used the bidet; I find her stooped, holding the fireman's pole with one hand, the other grasping her clothing which has fallen around her ankles, I arrive to circle her with my arms, my fingers grasping for the bands first of incontinence pants then her slacks. More often than not the waist band of the incontinence pants rolls in such a way to require untangling, and my hands sometimes require washing afterwards. We laughed this morning that 50 years ago we were so self conscious not to undress in front of each other, now I help her with most things, including sticking infusion needles into her lower abdomen.

Close female relatives, even if available, would be unable to perform some of these chores. Infrequently visiting district nurses are not on hand to assist with rescues off the loo or kitchen chairs. In respite accommodation she fears being left in large volume absorbing incontinence pants as was our ex-neighbour of some years ago, being bed-bound and having the pants replaced mid morning after a whole night of dribbling. She really is terrified of her fate should anything disable me or worse.

We both had great expectations of last Wednesday's visit to Hot Air City, expecting an increase in the flow rate of Apomine from the infusion pump or suggestions to modify her L-dopa scheduling. Although we didn't see the neuro in person, she was advised to continue the existing regime of medications without change. We are confused; granted we are facing the time of unstable reaction to medications but the "promise" of apomorphine being the way forward to improve her quality of life has yet to become reality. We have been told to use bolus injections with caution, that apomorphine is not a one way trip and can be backed out of, and now when a small change may have given enough improvement to remove the fears she has of attending the wedding (a two day trip for her by the way) no changes have been permitted.

The itchiness of her arms and face is declining, yet a few days ago the outer sides of her lower legs became very warm and pink, bumps and itchiness developed quite fiercely, needing cold packs and cloth wrapping to prevent her scratching.

I mentioned previously that after sewing for a time her hands become too sluggish to proceed. We are both beginning to doubt that the problem is bradykinesia. Yesterday she was confused when attempting to count a mixed collection  of coins saying "nothing is working out", she believes she is not answering the puzzles in her puzzle magazine, doing much more "looking up" on line, has difficulty using embroidery files on her computer and embroidery machine, shows an inability to flexibly change what is written on her meds schedule sheet. For instance, I included appropriate timings for possible bolus doses, firstly around 12 noon and then 4 hourly increments thereon corresponding I thought to "OFF" times. When I realised 12 noon was a little late, a time before 1130am being more appropriate, I advised her to take that first bolus earlier at that time. She didn't wish to, for her schedule (which I had typed!) stated 12 noon. Dammit all! I nominated the time of 12 noon, surely I can be god a say take it earlier??? I intend to set up a subscribed Lumosity account for her so we can monitor changes in  her cognitive abilities.

Yesterday she woke at 0515 telling me her foot was in a bag. Puzzled, I looked to find her left foot in a pillow case, the actual pillow on the floor. she had no idea how that happened. At 0815 about 1/2 hour after waking  she mentioned a headache in her left temple, a buzzing in her ears, toes were tingling and she didn't remember the pillow case. While seated on the side of the bed her BP was 134/89/55 at 0825 and a minute later standing 152/99/72. By 0850 the headache was dulling and moved across her forehead.

Yesterday, our Anniversary, we went to the Club for a lunch and had a fish dish each, mine a sword fish steak with pepper sauce, too spicy for her, so she had salmon and a cole slaw salad which she found dry, needing much salad dressing and sweet chili sauce for ease of swallowing. After lunch I super market shopped, she wanted to accompany me, but soon faded and needed to sit on her walker outside the super market.

Years ago a video clip of dyskinesia reduction when a PWP wore blue tinted glasses did the rounds of the PD groups. In remembering this I decided we should shop today for blue cellophane to try it out when she was walking, even though she does not display dyskinesia at such times. Firstly we went to her favourite rag shop where she only bought some cards and on leaving her hips began to "wobble"side to side so she had to sit on her walker while I went to the cash register. She walked out of the place to a junk shop almost next door where we found some shades of blue cellophane, again she needed to sit on the walker;  then into the next junk shop. In there she was unable to walk further, I attached the foot rests to the walker which was used to push her back to our car. I accused her of not taking advantage of a bolus as her difficulties began because that may have helped to keep her on her feet. Then I realised that I myself was a thick headed old fart who should have suggested the bolus as soon as I saw her difficulties. She took the bolus after getting back into the car, which possibly helped alighting from the car once back home.

After some lunch she was nodding off on her recliner before needing the loo and bed. She called for me at 1325 wanting to take her 1400 meds early because she her feet felt trapped and she woke with a fright. After 2pm she began some hand sewing, calling me at 1600 to say she was taking another bolus. Then a friend from the southern state rang so now she's chatting after I helped her up of a kitchen chair to her recliner.

In the car park at the Club yesterday we spoke to an old bloke I thought about my age. When our wedding anniversary was mentioned he told us he has been married for 67 years and he was 91 years of age; says all due to eating well and drinking grog. He advised that the last 17 years of marriage are the worst. Such is life.

I had just completed a spell check on the above when the phone began to ring; I had left my cordless extension from my dungeon with her to speak to her friend, so I was unable to answer this call. When the phone kept ringing and ringing, I stomped out to ask why she wasn't picking it up!! "I'm ringing it" she says, waving the VOIP extension in the air, "I'm stuck on my recliner and the CB radio is too far away on my trolley." An example of both how easy the disabled can become "stuck" and how useful two phone systems and a CB radio can be when a disabled person is in a bind. She needed her reading glasses.

Shortly afterwards to the loo for a business, needing rescuing via wheelchair to then get to her recliner, she being unable to walk, 20 minutes before meds time and no bolus because the last one was used at 1600. Not much flexibility is there?

Chapter 316 - Don't Know Where We're Going

Let's not become defeatist and depressed about all this. But since we have seen no "improvement" in her OFF states for the use of a bolus I decided to track her performance at a "walking test" yesterday, Saturday, from seated start from an armless chair at back door pushing her trolley to front door, return and sit.

0600 Usual meds Sin 100/25, Sin CR 200/50, Sif 1.5, Der 40, Mot x2. Pump still running.
0830 Showered and dried herself seated on shower chair.
0840 Pump started with new syringe 6ml Apomine + 14ml saline following  shower, 28.15 indicated on screen.
0845 Walk Test 28.75 secs. Video taken only of this instance.
0900 BP 139/96 66
0930 Walk Test 30.5 secs; left foot felt heavy
1000 Usual meds Sin 100/25, Sif 1.5,Der 40. Walk Test 29.34 secs. Left foot not as bad as earlier.
1100 Walk Test 29.44 secs. Heaviness in left foot wearing off.
1130 Walk Test 29.41 secs
1200 Walk Test 31.25 secs Says she is "exhausted". BP 114/61 68
1215 Walk Test 31.44 secs
1245 Walk Test 52.10 BP 131/81/72. Exhausted, needed fan blowing air, eyes closed while seated.
1300 Walk Test failed at 39.72 at 1/2 way point unable to proceed at front door, feet tingling, feels sleepy, tired, sipping water, rescued in wheel chair. BP 121/73 67. Applied Bolus, pump reading changed from 23.44 to 22.42, face does not look alert.
1315 BP 126/76 66. Drowsy, slow of speech, slightly glazed look to her eyes
1319 Falling asleep in wheel chair
1322 Sipping water
1325 Wants to lay down and sleep
1330 BP 128/76 68, then falls asleep in wheel chair
1333 Face suddenly brightened, sipping soda water, burps, yawns
1345 Unable to stand from wheel chair, unable to move to kitchen chair
1349 Left foot began tingling
1351 Her "horror" feeling across her shoulders.
1353 She said "everything itchy", yawning, almost sneezed.
1355 Walk Test 70.13 secs
1356 Legs ache, noticeably alert, eyes clear
1358 Use of walker to toilet to void.
1400 Usual meds Sin 250/25, Sif 1.5, Der 40, Mot x2.
1405 Remained on toilet, sensing bowel action but nothing happened, face hot, ear lobes very sensitive. Needed assistance to adjust clothing
1412 Walked pushing trolley back to her recliner.

At this point I left for my dungeon to do some on-line shopping

1500 (approx) Walked trolley to toilet and return by herself.
1515 (approx) Began hand sewing at kitchen table.
1542 Walk Test 32.81 secs, Toes curling and tingling.

The above suggests to me that she was ON earlier than 0830, the time of having a shower, until about 1230, with no observable OFF time prior to her 1000 meds. Then she went OFF from 1230 and was rescued by the Bolus prior to her 1400 meds (otherwise she may have been OFF until well after 1500 without the Bolus)

Perhaps it is possible to adjust her meds to avoid the OFF dip around 1230 onwards. I think if that dip were to be filled in then she may almost feel a "new" person.

So I prepared a schedule with the Bolus doses specified so that she may rescue herself before going OFF, but that has always been difficult for her determine, that point of going OFF. 

For instance, she may be hand sewing at the kitchen table ( where she keeps herself occupied these days, mostly, rather than her sewing room where she feels "cramped") and suddenly calls me on the CB when she discovers that her fingers are no longer supple enough to sew, whereupon she becomes scared because she is unable to rise from the chair, go to the loo, her recliner, whatever; by that time it is way too late for corrective action. So the new schedule dictates a Bolus at 12:00 midday, then 4 hourly after that, no sooner because the gendarme in the device prevents the extra dose sooner than 4 hourly.

Last week her arms and face became itchy, reminiscent of other summer weather when her sensitivity to sunshine became evident. I took her to Dr Flower who went through the usual check list of changes in foods, laundry powder etc that may have caused it. People are suspicious (perhaps I am self conscious) of the one arm covered, one arm bare sunshine test I performed on her some years ago. Although in this present case, I'm uncertain that she has been exposed to sunlight. And she has thrush this time. Usual prescriptions including anti-histamine tablets. Anyway, she mentioned she needed full sleeved blouses to protect her arms, This morning I suggested we go to that clothing shop she haunts whenever she has a voucher (yes one left from birthday presents). We left home shortly after 11am, parked in the god-awful car park, shuffled into the shopping centre, into the shop where she resigned herself to sitting on her walker while I grabbed suitably sized bits of filmy stuff for her to inspect. Waiting at the counter with both voucher and credit card I convinced her to push the Bolus button, she did, at 11:40am. Leaving the shop, she wished to wait awhile before entering the car park, she on her walker, me on a bench seat. Twice we saw the girl (woman way less than 50) who is coming to our place tomorrow to cut her hair as well as mine (I have opted out of my regular barber; too long away from home, too early attendance to have the barber himself, so if a woman is to hack my hair then it may as well be done at home). Anyway, after 20 minutes she was capable of returning to the car. On the way to the Club for lunch I intended to go to our chemist in the other shopping centre but escaped from a nasty traffic jam as two anal cavities towing full height vans attempted to enter the car park to discover their A/C's were about to be scraped off by the height restriction across the roadway. Although my reactions bothered her, a 3 point turn got us out of there and onwards to the club.

At the Club we needed to swap meals because the chicken stir fry she had was too spicy for her so she exchanged for my Thai beef. Potential itch reaction meals I imagine. Then we finished off with too much cake and ice cream. Arrived home stuffed.

Thursday last in Hot Air City again to see Polly the PD nurse and the Considerate Neuro. In attempting in my usual light-hearted manner to suggest that PD professionals should live with their patients for awhile to fully assess their symptoms and capabilities I think I was mis-understood by Polly. Then the Considerate Neuro mentioned later that Apomine was not a one-way trip, that it was possible to back out. Rather than back out, we need to see more adjustments to her pill/Apomine regime to iron out this rocky road we are on. Anyway, another visit this coming Wednesday.

Her neuropathy (that's what I believe it is) has lessened when I measure its impact on her; she still has toe tingling/bending and leg aches and cramps but without taking all of her attention. When I think to do so, I keep a glass filled with soda water, her nightly wakenings to piddle are fewer, she wakes me less frequently for assistance. So why do I remain shagged out most days?