THINKWELL

AGEWELL

Elaine’s Story: Resilience, Memory Care, and Hope in Aging

00:00:00:02 – 00:00:14:08
Speaker 1
In the one that I’ve been doing for a while. There was one woman in it. I didn’t want to see her in there because I could tell she hated it and she was miserable. So then I went to this other one. I’m going to now, and everybody there is. They’re just like angels. They know what to say, you know?

00:00:14:08 – 00:00:23:17
Speaker 1
They’re serious and they’re happy. And I have a feeling that it’s going to help me a lot get through some of this.

00:00:23:18 – 00:00:53:23
Speaker 2
Welcome back to the Think Well Age Well podcast. I’m your host, doctor Heather Sanderson. And today’s conversation is a really meaningful one for me. I’m joined by my dear friend and brilliant colleague, Doctor David Merrow, along with his mother, Elaine, who spent six months living at Marama. Doctor Merrill is a geriatric psychiatrist, neuroscientist, and the founding director of the Pacific Brain Health Center at Pacific Neuroscience Institute, where we work together to support patients suffering with dementia.

00:00:54:01 – 00:01:30:11
Speaker 2
He’s devoted his career to helping people preserve and improve brain health as they age. Combining cutting edge research with deep compassion for patients and their families. Along with his personal experience of watching and supporting Elaine through her process. Today’s conversation isn’t just about the science. It’s deeply personal. Elaine is graciously joining us to share her first hand experience of both living at Marama and navigating the medical system, as she’s struggled with her ability to read and to remember and to cope with aging.

00:01:30:12 – 00:01:54:00
Speaker 2
This conversation is a rare opportunity for us to explore aging well, from both the perspective of a world renowned expert and a loving family member navigating this journey in real time. Welcome, Elaine, and welcome doctor Mario and Elena is also joined by her husband, Mike. So thank you all for joining us. I’m excited to dive in. Elaine, what were your first experiences?

00:01:54:00 – 00:01:59:01
Speaker 2
When did you first notice something wasn’t quite right?

00:01:59:03 – 00:02:22:08
Speaker 1
This is where I have to ask Mike, because it’s one of those things that, I don’t really know, and I, I have an idea that I should know that I did know. But, you know, the individual experiences, like, I really can’t get a hold of. Mike. You asked me not too long ago. One of the first things that you noticed.

00:02:22:10 – 00:02:50:06
Speaker 3
About four years ago, you ran a restaurant, friends, and we went to check on a dog in the car. It was about a block away, and she had difficulty finding her way back to the restaurant. Yeah, that was about four years ago now, and we just I didn’t realize what was going on at the time. But as time went on, her ability to drive became much less.

00:02:50:08 – 00:02:55:02
Speaker 3
And, she didn’t recognize a broader range of what was half of it.

00:02:55:05 – 00:02:56:13
Speaker 1
It didn’t hurt anything.

00:02:56:17 – 00:03:11:12
Speaker 3
There was a time where, when we realized that eyesight and ability to drive would go away, we still didn’t realize what was going on. But that was the first indication. As, Yeah, something was up.

00:03:11:14 – 00:03:33:00
Speaker 1
Yeah. I mean, when I, when I tried to get back to where we were at the restaurant, you know, it was it was dark, but there’s light and everything’s, you know, it was a commercial area and I suddenly didn’t know which way to turn. So I had to call Mike, who was, you know, what’s the other people that were with that Dan?

00:03:33:04 – 00:03:40:01
Speaker 1
And, it just was so puzzling as how come I don’t know where I am? Of course I know where I.

00:03:40:03 – 00:03:44:22
Speaker 2
And the next steps that you took to understand what was going on.

00:03:45:00 – 00:04:07:18
Speaker 1
At that point. Really nothing. Just that it was weird. And maybe, you know, we didn’t every day go to that particular place, but I didn’t want to make a wrong turn. Yeah, because I had the dog with me. And, you know, if I went the wrong way, it might take them a while to come find me. So we both kind of just thought it was an isolated end and something, you know, and now.

00:04:07:18 – 00:04:28:19
Speaker 1
But but then next thing, we live in West Sacramento and we pretty much stay around here all the time. And Sacramento itself, it’s a lot busier and a lot more. You know, you have to really sort of be on your game when you just go there. But I haven’t had any trouble doing that. How long have we been there at that point?

00:04:28:19 – 00:05:03:02
Speaker 1
Probably, you know, 5 or 6 years. It’s not like what’s new. A lot of the streets are either east or west, but they’re not. They’re one way going different, different places. And I just missed it. I didn’t see it. I was going pretty fast, you know, as people do when they drive. And, and I, I flew over from one of the things that you’re supposed to go around and, and I pulled over to the side and I looked at the car and it looked okay to me.

00:05:03:02 – 00:05:13:05
Speaker 1
I drove, okay, so I, I went home, drove home. But it was it was that was a real eye opener. Well, why on earth did that happen?

00:05:13:06 – 00:05:35:17
Speaker 2
Definitely a big scare. I think often the patient themselves, a person experiencing this, isn’t always aware that the changes are happening, and sometimes it takes a family member like Mike or David to noted that something’s changing. I’m curious if David, if you or your brother noticed that there were changes happening with your mom before she did.

00:05:35:19 – 00:06:07:14
Speaker 1
Yeah. Well, thank you, Heather. First of all, for having a son, it’s an honor and a privilege to join you, on the podcast. So when things first started changing for my mom, I think we were much more kind of the common family. Feeling like she’s okay, everything’s normal. How are we going to get this over with or get, you know, get past this kind of a sense that normal is still going to be normal.

00:06:07:14 – 00:06:28:12
Speaker 1
There’s not going to be a new normal. So for the first few years, I mean, it didn’t Covid didn’t help because there was all this separation and isolation to where we didn’t actually get up to Sacramento for quite some time. So some of those I found out about are most of it I’d say I heard about well, after the fact.

00:06:28:14 – 00:06:55:20
Speaker 1
But then I think, mom, you were going to start talking about your checkbooks and how you’ve always been meticulous about dollars and cents and tracking numbers and keeping everything balanced down to the penny. And I remember you texting me photos of your handwritten checkbook, where you were making corrections and weeding out the entries and trying to get to zero.

00:06:55:20 – 00:07:27:04
Speaker 1
And you’re just sharing with me that you weren’t able to, and that there must be something wrong beyond just normal aging or senior moment. And at that point, I think we did start talking about things that had gone on, like you’re driving. And I was actually Heather to what you were alluding to about self-awareness. I have continued to be really struck by how deeply self-aware you are.

00:07:27:06 – 00:07:50:14
Speaker 1
Mom, about what you’re going through. I mean, for example, you gave up driving voluntarily. Like you didn’t need to be reported to the DMV. We didn’t need to pry the keys away from your hand. You know, heaven forbid, Mike, that you would not be able to drive, because I would think it would be the opposite where, you know, if you want.

00:07:50:16 – 00:08:20:11
Speaker 1
Okay. I want to make sure that, what actually happened. And I’m not sure my doctor told me. I told her about doing that and telling her that nothing was harm, but I was, you know, I, I just, I don’t know, I, you know, we like our doctor that was talking to her. And at the end of our session, she said to me, I’m really sorry to tell you this, but I’m going to have to report it to the DMV.

00:08:20:13 – 00:08:54:06
Speaker 1
And, you know, I thought, well, I thought about it for a while, and I kept on driving for about a week, and then I thought, what they said is I would have to take my test again and go to the empty. And I thought, you know, I don’t think that’s really a good idea because it did shake me when I went over this thing that, you know, you know, my reaction at first was, you know, there’s people in Sacramento are legendary for how fast and stupid they drive.

00:08:54:07 – 00:09:18:16
Speaker 1
And I thought, you know, it couldn’t have been me. It must be all those people. And then I just I told Mike, I said, I’m not going to go and take my test. And I don’t feel that’s right. And so it went away. Well, thanks. Because I remember you telling me, being able to tell the difference between the left side of the road and the right side of the road became more challenging.

00:09:18:16 – 00:09:31:07
Speaker 1
So you didn’t know if you were on the correct? Yeah. That of the street. I don’t know how how much you have driven in Sacramento and it’s not just me. Everybody says this is what.

00:09:31:09 – 00:09:42:15
Speaker 2
A lot of your experience is visual. Can you describe it because you don’t have a classic Alzheimer’s type dementia? Can you describe your experience?

00:09:42:17 – 00:10:06:19
Speaker 1
It’s so hard because it goes away. Well, I it’s hard for me to remember, but I at first I thought, you know, oh, well, I’m losing my vision means I’m going to everything’s going to get dark, but it hasn’t gotten dark at all. It’s just sort of it’s really hard to explain it. Like I’m looking at you both and then I can do this and it kind of helps sometimes.

00:10:06:21 – 00:10:09:06
Speaker 1
Yeah, that helps a little bit.

00:10:09:08 – 00:10:10:19
Speaker 2
If you put your seven.

00:10:10:19 – 00:10:32:19
Speaker 1
Yeah. But it’s just different. I think a lot of it is, what do you say when, when something is, there’s something here and then there’s something that they don’t. Thank you that your depth perception is that’s the real issue. More than the light or the dark.

00:10:32:20 – 00:10:33:18
Speaker 3
It’s something off a.

00:10:33:18 – 00:10:37:15
Speaker 1
Curb, stepping off a curb. I don’t know if it’s like this or like this.

00:10:37:17 – 00:10:39:06
Speaker 3
Escalator.

00:10:39:07 – 00:11:11:17
Speaker 1
Oh, escalators. Forget it. Which. Mom? I’m, I’m not trying to make you cry, but, you know, my mom, her whole life has been an artist. She has a masters of fine art and photography. She’s a masters in English lit. So her world, the depth of her human experience has been reliant on visual spatial experience. Depth of field and also the composition of writing.

00:11:11:23 – 00:11:41:07
Speaker 1
So these have been really at the core of her lived experience is visual spatial navigation, the process of reading and writing. And though she has this syndrome, which is a less common form of Alzheimer’s called posterior cortical atrophy for her, like the loss of the ability to navigate space or to write or to enjoy reading has been difficult.

00:11:41:07 – 00:12:12:10
Speaker 1
I don’t, you know, mom, how’s that been? That’s his thing. Well, you did do. Yeah. No, it’s it’s it’s the core. That’s what I tell people that say I can’t read. I can’t write. Other than that, everything’s great, but. Yeah, that’s saving me a little bit. I have two things that I think one of them I know, that I can do books on tape, which now called is called Something Else, but that’s what it is.

00:12:12:12 – 00:12:13:01
Speaker 1
And the other.

00:12:13:01 – 00:12:13:16
Speaker 2
Thing I’ve been.

00:12:13:16 – 00:12:40:01
Speaker 1
Meaning to ask you, David, and I know that I take medication for anxiety, and I wonder sometimes it feels like I get so much medication that I can’t feel anything. And I don’t know if my my reaction is true or if it’s, you know, I don’t know. I very rarely really cry like boo hoo hoo. You know, I call it boo hoo hoo.

00:12:40:01 – 00:12:55:19
Speaker 1
I don’t know who to read, but I, you know, I get upset and I get I get down crying like this. Mom, I think your resilience has been remarkable in the face of these losses.

00:12:55:21 – 00:13:18:20
Speaker 2
Everyone needs to get out their tissues. I mean, I remember learning that you spent a career in publishing and your life your career was about as as David mentioned, it was about your visual spatial experience and the ability to read, to engage in stories and travel and all of these pieces, you know, they’re different now. They’re I wouldn’t say that they’re entirely lost.

00:13:18:20 – 00:13:46:20
Speaker 2
You found incredible ways to cope. I think another part of your experience that is unique, of course, having David as a son with his expertise, you were able to handle understanding far more about what was going on in your brain. I think many people expect that if they have dementia, if they’re going to have an Alzheimer’s diagnosis, that it will be a short term memory that will go first way.

00:13:46:20 – 00:14:09:18
Speaker 2
When you’ve had this very different experience and I think sometimes when it’s not typical, when it’s not textbook, it can prevent people from getting the medical help or the diagnosis that might help them most. Doctor Merrill, do you have any thoughts about that and how other people might navigate? You know, you even had this experience, oh, mom’s going to go back to normal, not have a new normal.

00:14:09:20 – 00:14:16:21
Speaker 2
What would you recommend to people as a patient, as a doctor, if these types of things are coming up?

00:14:16:23 – 00:14:35:09
Speaker 1
Sure. You know, it took us as a family again, being on the care partner’s adult son side of the equation, not the clinician. It it took us quite some time to figure out what was going on. You know, I’d say it was more years rather than months.

00:14:35:11 – 00:14:36:15
Speaker 3
Is the year, Nance.

00:14:36:17 – 00:15:02:12
Speaker 1
Thank you. Mike. It was about a year and a half. It took us to get a diagnosis of posterior cortical atrophy, which is most commonly a variant of Alzheimer’s. So it was originally discovered down at UCLA by some of my academic, senior mentors. It’s now appreciated to be it used to be like rare cases, like there was only 50 known cases that have been described in the literature, but now it’s it’s appreciated.

00:15:02:12 – 00:15:42:17
Speaker 1
A recent study from UCSF found that upwards of 5 to 10% of Alzheimer’s cases, can essentially be manifesting as posterior cortical atrophy, which, as we’ve talked through, is is less common presentation of trouble with visual spatial navigation, construction of visual objects, but relative sparing of short term memory, at least initially. And in a way, it’s kind of a silver lining for for my mom and for our family that it is a form of Alzheimer’s that has a slower rate of progression.

00:15:42:17 – 00:16:14:06
Speaker 1
There is a preservation of self-awareness, and that can be used to our advantage, in which my mom just said, like, instead of reading a book, she’ll listen to a book, mom, in addition to being highly intelligent. So having a high baseline you’ve had years, if not decades of formal and informal education, so you have a large amount of cognitive reserve to buffer against the loss of synaptic connections, the decline in brain cell function.

00:16:14:08 – 00:16:38:09
Speaker 1
You’ve been able to maintain a lot of your activity. So enjoying listening to books I know. Thank you mom for you actually rescheduled your book club from right now to have this podcast, so thank you for doing that. But it’s really been a story of your resilience, more so than succumbing to a hopelessness or a feeling of there’s nothing we can do, if anything.

00:16:38:11 – 00:17:11:22
Speaker 1
Once we knew the diagnosis that took another period of time. Heather, for us to find you and the story of Marama, which really, you know, it changed the game for us as a family, for my mom, mom, I think that’s why you don’t cry as much or as often, is that you’re really in a better headspace at this point in terms of having agency to be active in your own rescue.

00:17:12:00 – 00:17:13:03
Speaker 1
Yeah. And I mean.

00:17:13:03 – 00:17:17:10
Speaker 2
Would you describe your experience at Marama?

00:17:17:12 – 00:17:42:22
Speaker 1
Yeah. As for the experience, it was profound. It was really, and there was so much available activity and interest and and you’re funny guy who? Brian. I can’t remember his name, but you know who I mean? Who came and made Joe. Oh, wow. Mom, if you’re right, if you’re bringing up Brian. Glad I just. Wow. Okay, I have it.

00:17:43:00 – 00:18:03:12
Speaker 1
Hi, Ryan. You’re the best. I have the car with you ladies. Yeah. Way to go, Ryan. Yeah. Everybody just loved him. Couldn’t wait till he came back. But there were other people, too. Like, there was a guy who was some kind of a crooner who would come in with his piano and la la la, you know, there was just.

00:18:03:12 – 00:18:27:03
Speaker 1
And all of the activities and the people that were there, it’s it’s kind of sad because as when we all sort of broken up, broke up unexpectedly, everybody said, oh, well exchanged. We exchanged, you know, our cards or something. We’ll stay in touch. And we didn’t. Everybody just go away. And that was kind of sad.

00:18:27:03 – 00:18:53:13
Speaker 3
I mean, a a point to go out and buy a read every six weeks on a weekend to see what was going on. As long as Lynn’s was there, she was engaged and active. And while her cognition is still pretty good, but it, it, it was pretty good seeing, you know, stayed active was in great good spirits and, they kept her and they kept her busy and engaged.

00:18:53:15 – 00:18:58:13
Speaker 3
That was the best possible, solution, for her.

00:18:58:15 – 00:19:35:20
Speaker 1
Yeah. And, one of the things in my life that I’ve had that I’ve always been, kind of prideful about is that I was a long term runner for years and years and years. And then we had that, that hill that we had to go up and down once or twice every day. And I made sure that I was the one who was the strongest and the longest and, and, a little competitive, but, that was, that was one of the, the highlights of that, that everything was that that was needed was right.

00:19:35:20 – 00:19:47:13
Speaker 1
Right. There was somebody saying, okay, it’s time to do this now. Now we’re going to go down the hill, you know, and, you don’t feel so good. Well, we’ll we’ll take it easy. You know, the people were just so.

00:19:47:15 – 00:19:49:11
Speaker 3
It was a good selection of work.

00:19:49:13 – 00:20:13:17
Speaker 1
Yeah, yeah. And I might as well throw in that right now. I’ve been going to, I always say it wrong because I say it’s babysitters. Daycare. Daycare. Yeah. And I found that the difference in the, in the one that I’ve been doing for a while, there was one woman in it. I didn’t want to see her in there because I could tell she hated it and she was miserable.

00:20:13:19 – 00:20:33:16
Speaker 1
So then I went to this other one I’m going to now. And everybody there is, they’re just like angels. They know what to say. You know, they’re serious and they’re happy. And I have a feeling that it’s going to help me a lot get through some of this. And two days a week now for a full day, I’m going to be doing it.

00:20:33:16 – 00:20:39:02
Speaker 1
And and this I’m not around this other poor sad woman that was there.

00:20:39:04 – 00:21:06:17
Speaker 2
It can be infectious, right? Instead, there’s a couple things I want to highlight about your experience. Elaine, when is it you have genetic risk for dementia? Quite significant genetic. Yes. You’re ApoE4 for a positive. And yet again, your resilience is a big part of this story. And I think, you know, David used spoke to just how actively engaged you’ve been, Elaine, your entire life, how you’re highly educated, you’ve got at least two masters.

00:21:06:17 – 00:21:36:02
Speaker 2
You’re a lifelong learner. You’re good at pivoting and coping and being able to stay engaged. But you also have been a lifelong runner. You’ve been an avid exerciser, which I am sure has has done a lot to protect your brain. And so it’s possible that you might have gotten a more severe form of Alzheimer’s or an earlier onset Alzheimer’s if you hadn’t been engaged in these very active lifestyle activities throughout your adult life.

00:21:36:02 – 00:21:41:09
Speaker 2
And, Doctor Merrill, do you have any thoughts on that or anything to add to that?

00:21:41:11 – 00:22:05:18
Speaker 1
Absolutely. Heather. Mom, you know, I still remember as vividly as possible for me at this point on your 50th birthday, you ran your first marathon in San Francisco. And, you know, I was still a young adult, so I was, a little late waking up. But, you know, Mike had followed you along the course of the night.

00:22:05:20 – 00:22:16:15
Speaker 1
I managed to get to the finish line just after you were done. But that photo of you at the finish with Mike. And who was there also?

00:22:16:20 – 00:22:17:08
Speaker 3
My bird.

00:22:17:11 – 00:22:32:16
Speaker 1
My bird? Yeah. One of our, Right. So running, I didn’t I don’t want to, but, you know, McMillan really forged their relationship as part of the runners club in Oakland. Was that group called Mike Lake?

00:22:32:16 – 00:22:34:00
Speaker 3
Merritt joggers? Striders?

00:22:34:00 – 00:22:40:17
Speaker 1
Yeah, yeah, yeah. And, we went we went to Hawaii together to do a marathon.

00:22:40:19 – 00:22:41:14
Speaker 3
That was my first year.

00:22:41:19 – 00:23:10:15
Speaker 1
That was your first time? Yeah. So that all of that was very positive. My mother had the Alzheimer’s or it’s called something else, but it’s essentially that she. She was a smoker and it was something about that that made her difficult. And my dad had the other thing, the one that where people get violent and yell at their partners, Parkinson’s.

00:23:10:15 – 00:23:40:08
Speaker 1
And my dad had Parkinson’s and my mother had no. So you’re right, there were, opportunities for mischief in my body. And. Yeah, so so they expect the age of onset. And forgive me for looking at the evidence base while we’re talking expected age of onset for a woman with ApoE4 fours about age 65. Whereas, mom, I think your onset was closer to 75.

00:23:40:10 – 00:23:43:10
Speaker 1
Yeah. Sounds right. Yeah, yeah.

00:23:43:12 – 00:23:44:21
Speaker 3
74 okay.

00:23:44:23 – 00:24:06:14
Speaker 1
So yes, I don’t think I got the one where people start to yell at each other, but my dad did. Yeah. Your dad grandpa was a professor of English lit at University of Nevada, Reno. Reno. Sorry, where you were from and grew up. That’s even fog. Yeah. For me, I was pretty young when he developed initially Parkinson’s.

00:24:06:14 – 00:24:33:18
Speaker 1
And then they. I recall being told that he essentially had mixed Parkinson’s and Alzheimer’s with these kind of. He. Yeah. I feel so special. Right. And then it wasn’t until years later your mom ended up with a vascular dementia. That’s what it was. Yeah. Really? From having been the stress of all that and then also age itself and being a chronic, smoker.

00:24:33:20 – 00:25:03:02
Speaker 1
And so on the one hand, it’s been a shock to us all, mom, that you have Alzheimer’s, but then learning more about you and the genetic loading of having the ability for, for genotype, you know, scientific journals and population studies. Now kind of say that if you have 8.44, it’s deterministic, that if you live long enough, you will end up with the Alzheimer’s disease.

00:25:03:04 – 00:25:27:16
Speaker 1
You know, I’m not so convinced that that’s the case. But in that regard, you know, your life is a testament to how to delay onset, to lessen the severity of the condition. We’ve talked to a lot about your education background, your, thirst for knowledge and learning. I think one of the most striking examples. And you can correct me if I’m wrong.

00:25:27:18 – 00:25:51:03
Speaker 1
You were a a traveling author and an editor for Lonely Planet Travel Guides, and I remember there was a an etching like a photo of you, which was an etching of you running at one of the places you were writing about. I can’t remember if it was Hawaii or Australia, and to me that’s just like a vivid. Yeah, yeah, I forgot about that.

00:25:51:05 – 00:26:14:13
Speaker 1
Yeah, I know, I went to Australia with some of the other people from, Lonely Planet, you know, to, to go down under and and see really because they’re really the base of Lonely Planet. True. Right, right. Exactly. So, so, you know, Heather, it’s, you know, my interest in health behaviors was born out of growing up under my mom’s care.

00:26:14:13 – 00:26:43:18
Speaker 1
And guidance. We were we were a vegetarian household. There was a lot of sprouts. And I have to admit, bagels, were a favorite. But that’s an interesting transition to where we now know that for the demanding my brain. So I put it that way. But when with vulnerability to a dementia in later life, it may actually be best to be on this lower carbohydrate, if not, frankly, ketogenic diet.

00:26:43:19 – 00:27:08:12
Speaker 1
Sorry to jump ahead in the lingo, but this has been a process that my mom has embraced, starting really with the living at Marama, which Mike has been supportive of, both there and coming back. Now, my mom does her best to be in mild ketosis, to follow the ketogenic diet based on the prayers protocol, and she sometimes.

00:27:08:14 – 00:27:09:22
Speaker 2
Everyone does your.

00:27:09:22 – 00:27:42:00
Speaker 1
Human continue. Yeah yeah. So to see that transition from high carb, low fat, low protein 1980s diet to like modern day keto flax, yeah has been fascinating to watch. And I think a big difference maker. And why mom you’ve done so well and you still have great strengths and your verbal comprehension, your frontal executive function. Ultimately, you need some prompting for recall.

00:27:42:00 – 00:28:01:19
Speaker 1
But once we get going, you knew that your book club is this morning and your gardener was here. And I mean, you’re very with it in terms of you’re very much you. Mom is still mom, which is great, I agree. And sometimes it’s it’s too much, you know, it’s I don’t want to be negative, especially in hearing what you’re saying.

00:28:01:23 – 00:28:26:23
Speaker 1
I agree, I, I wake up a lot of times and I forget until I get out of bed and then I. Oh, yeah, not not quite the same. Mom, can you talk a little bit about the adjustment from being a vegetarian? Who? You gave me a fridge magnet once that said, I’ve never met a carbohydrate I don’t like and I well, you know, that was I runners.

00:28:27:01 – 00:28:54:05
Speaker 1
She and I are related, so it’s kind of like self-disclosure. It’s I really struggle with the low carb guidance, especially with things like just the decades of controversy and history and nutrition and diet related to health. So, mom, can you speak a little bit to the process of embracing the ketogenic diet and what that’s been like both at Marama and you’ve been back home for more than a year, more than a year.

00:28:54:05 – 00:29:23:15
Speaker 1
And like how it’s. So it took a while while I was still at Marama, but I like it, and I feel so guilty because those two are animals. I wrote that was that was the impetus for being veggie, was, you know, making the the cows feel better, but that the way we eat right now, I really I mean, mostly me, I guess because it’s expensive, but I just like it.

00:29:23:15 – 00:29:35:20
Speaker 1
I enjoy it, and I don’t want a lot of carbohydrates only I still really love ice cream, I have to say. So now and then I do that. But it’s just like.

00:29:35:22 – 00:29:36:15
Speaker 3
Maybe once a.

00:29:36:15 – 00:29:41:20
Speaker 1
Month. Yeah. It’s it’s, it’s a it’s it’s been really good for me.

00:29:41:22 – 00:29:58:02
Speaker 3
One of the things that that I got from Marama was to keep a lean busy actively mentally busy and, and that’s with the daycare. They, they have activities for her all day and the keto diet.

00:29:58:04 – 00:30:17:17
Speaker 2
So, Elaine, one of the things that I really wanted to highlight about your experience at Marama was how you utilized it, the way I imagined when we created it, you know, you had to make the hard decision to leave make up in Sacramento, to come down to San Diego, to leave your loved one and your your routine, your day to day, your life, your routine.

00:30:17:19 – 00:30:48:18
Speaker 2
But it was also this big reset where you were able to spend six months in this fully immersive experience where you were getting the diet and the exercise and the activities and the social engagement. And then in that transition back to Sacramento, you were able to take a lot of it with you. So one of the things has been the diet, and I’m curious about the resources that you’ve used and how you navigate staying primarily in ketosis and having a vegetable rich, very healthy diet.

00:30:48:23 – 00:30:53:03
Speaker 2
Now that you’re back in Sacramento, can you share with us how you’ve done that?

00:30:53:05 – 00:31:29:22
Speaker 1
Yeah, I, I can I want to just say something to David. One of the good things about Marama was he chose the bedroom that I should take, and it was the very best choice. It was at the end of no, because nobody would come back there and I could go outside under where the the, you know, the patio, the patio up on my by myself and and sit there or walk a little bit and you know, nobody ever bothered me in the mornings.

00:31:30:00 – 00:31:51:23
Speaker 1
The only people I ever saw were the ones that were just leaving and they’d been working all night. And that was a big thing I want to make sure to, to give credit to my son anyway. Yes. So thank you. You kind of laughed when you said this is the best one in the house. And it was so anyway, what did you just ask me?

00:31:51:23 – 00:31:53:06
Speaker 1
Other than that.

00:31:53:08 – 00:32:02:07
Speaker 2
You’ve been home for about a year and you’ve been able to stay on the ketogenic diet. What resources do you use to maintain that?

00:32:02:09 – 00:32:19:13
Speaker 1
Boy, that’s a good question. I have to think about it because it just so it’s Mike who who really, toes, toes the line here because he doesn’t we don’t always eat the same thing. And who am I thinking of also that talks about this?

00:32:19:15 – 00:32:20:12
Speaker 3
Ingrid.

00:32:20:14 – 00:32:43:20
Speaker 1
Oh, Ingrid. Right. To the person who does that. This kind of, you know, she she was she was a restaurant owner for a while, and it just didn’t work with her. And so she got this idea, and, every time that she comes, she goes through everything that she’s suggesting sometimes, you know, saying, would you rather do this or do that?

00:32:43:20 – 00:32:58:02
Speaker 1
Or else she’d just say, and on this one, we’re going to do this way. And I don’t always know what they are and what what, but she’s very kind and she’s very open, and I would just give credit for her. I,

00:32:58:04 – 00:33:12:18
Speaker 2
New chefs, very seniors. Right. Chefs, we’re seeing you. Not one. You were able to use that to find Ingrid as a chef who could come to your house, and it’s. You do the grocery shopping for you. Does she pick out recipes or do you give her recipes? How does that work?

00:33:12:20 – 00:33:37:10
Speaker 3
Or she has a she has a rotation of all the step that takes weeks or on rotation. She comes, every other week and every third time it starts to repeat itself. So she makes three different types of types of different dinners falling. And, not that she makes every dinner for when, you have to supplement, oh.

00:33:37:11 – 00:34:07:07
Speaker 3
We do that in a restaurant when we sleep, you get a Cobb salad for, a lane or, subway. We we get a, protein bowl out with heavy, spinach. We get a lot of, there’s a keto keto yogurt. I’ve even found a, keto brownie index. Wrong. So we get, And I’ve tasted it and quite, not quite 100% pretty good.

00:34:07:09 – 00:34:33:11
Speaker 1
From from my perspective. I think I think I must have cooked a lot of dinners when my kids were young, and I have no real recollection of all that I would be. I would be a woods now if I had to go in and make dinner. I mean, so between Mike and Angus in a they are they’re the bosses.

00:34:33:12 – 00:34:35:17
Speaker 1
I can’t tell you.

00:34:35:19 – 00:34:55:19
Speaker 3
She gets a break. Bacon and eggs. Probably five out of seven, breakfasts. Go with a keto Peter toast. There’s a, there’s a granola. Yeah, we have a couple times, a couple times a week. Not in the mornings. I’m in a hurry to get her off to, get her off to her daycare.

00:34:56:00 – 00:34:57:06
Speaker 3
So.

00:34:57:07 – 00:34:57:16
Speaker 1
Yeah.

00:34:57:20 – 00:34:58:23
Speaker 3
And,

00:34:59:01 – 00:35:12:19
Speaker 1
I I’m I’m being taken care of. That’s all I know. And and it sometimes just stymies me how I spent, you know, five, ten, 15 years cooking. I. I must have done okay.

00:35:12:21 – 00:35:20:19
Speaker 2
If someone were considering, six month stay at Marama or longer, what advice would you give them?

00:35:20:21 – 00:35:42:20
Speaker 1
I would kindly, I think, remind them to do as much as they could because as you may have noticed, as you’ve come and gone a little bit, a couple other people who were in it didn’t want to be in it, and they would take first the first chance they got to go back into their room. There were more.

00:35:42:20 – 00:36:09:11
Speaker 1
There was more than one person who really wanted to do that. And of course, that’s really hard on the, the helpers and the staff, you know, to realizing that, oh, he or she, they’re gone again. And I would just say it is hard, you know, but you’ll you’ll be happy if you get it done and you may find yourself like later that you regret it.

00:36:09:12 – 00:36:23:17
Speaker 1
But it’s it’s so individual. You know, some people, they just can’t make it to do it. But I, I was determined not to be one of those people, even on a bad day that I wasn’t of, you know, I mean, here.

00:36:23:19 – 00:36:26:13
Speaker 3
Utilize utilize the program.

00:36:26:15 – 00:36:55:16
Speaker 1
Yeah. Yeah. And and when we would do things that were work group, I would try to give other people what they they would say and I would try, you know, I’d try to even do this when I go to daycare. If I see people, you know, who are more. Well, I was a mom, you know, just to to realize the opportunities that I had, no matter how.

00:36:55:18 – 00:37:24:04
Speaker 1
And I don’t want to set myself up because sometimes I just can’t do stuff with this. But I’m aware and I, I take from my kids autism. I’ve always been really active and interesting to do things and now you know that, those my boys are so great at Max. I understand how rare that can be. So I want people to be.

00:37:24:06 – 00:37:47:16
Speaker 1
You know, I don’t like to see people who said you did a great job, mom. Moving, you know, transitioning to Marama and really keeping an open mind and embracing, the unfamiliar and taking a jump, a leap of faith, first of all, to move in. And then second of all, you know, one of the greatest, aspects of the program is the structure.

00:37:47:16 – 00:38:15:12
Speaker 1
And following the protocol for things that you’re in your wheelhouse, like leading the charge, marching up the hill, but then also agreeing to do the things that you might never have heard of, or kind of have questions or doubts about how there are, you know, I haven’t visited in Kansas, but, facility in San Diego had this wonderful, it was a basically combo.

00:38:15:12 – 00:38:57:00
Speaker 1
I mean, you can probably describe it better and I can’t, but it was a combination exercise and detox circuit mixed with, like, you know, brain stimulation. So basically a circuit room that. Mom, you were pretty, regimented about jumping in for the circuit training sessions. And I’m curious to hear more of your do you recall some of the the tools they had to use there, or maybe Heather, you can share with the audience what what the interventions are that you’ve got set up there and that you encourage people to seek out, for those who can’t live there.

00:38:57:02 – 00:39:03:15
Speaker 2
Yeah. Elaine, do you remember your experience in the Brain Gym, in the Casita doing that?

00:39:03:17 – 00:39:04:03
Speaker 1
I’m sorry.

00:39:04:04 – 00:39:19:23
Speaker 2
Say again, do you recall your experience in the Casita, the brain gym where we had the levo to set up the exercising with oxygen therapy and the saunas, the rebounders, the red light therapy? Do you remember that?

00:39:20:00 – 00:39:24:16
Speaker 1
Not immediately. The rebounder. Watts.

00:39:24:18 – 00:39:28:10
Speaker 2
It’s the trampoline that helps. Oh, freedom.

00:39:28:11 – 00:39:30:14
Speaker 1
In in in the gym. Yes.

00:39:30:16 – 00:39:31:15
Speaker 2
Yeah yeah.

00:39:31:17 – 00:39:32:05
Speaker 1
Yeah.

00:39:32:07 – 00:39:49:09
Speaker 2
Yeah. So typically you would go down there in the afternoons as a group and we would have a handful of stations. So there would be a person on each station and then you kind of rotate. And on days when somebody wasn’t feeling up to it, they could hang out on the bio mat, which is a warm kind of harder mat.

00:39:49:09 – 00:40:02:14
Speaker 2
They can be really relaxing to take a break on, maybe even take a nap on. But for the most part, we were encouraging people to get on an exercise bike or a rower. Yeah, yeah. And use the oxygen it.

00:40:02:16 – 00:40:03:17
Speaker 1

00:40:03:19 – 00:40:24:00
Speaker 2
So we have the same setup in Kansas. It’s in this beautiful sun room and it’s, it’s a little bit bigger space. Even the one that we had in San Diego. And so it’s a really inviting space to get into. And your baseline, one of the things that really struck me from your experience at Marama was that you were willing to do the work that you showed up and you engaged fully each day.

00:40:24:00 – 00:40:45:04
Speaker 2
And in fact, not only that, but there were people who came later than you where you were kind of like the big man on campus. You had already, had your experience. You were you were settled in. And do you remember Karen coming? And she was really this was the first time she was living away from her husband and she was very anxious about the transition to Marama.

00:40:45:06 – 00:41:05:07
Speaker 2
And you really took her under your wing, and you made her experience much easier and more enjoyable. You were very encouraging of her and it really changed. I think what could have been kind of a disaster for her moving and, into a positive a really positive experience.

00:41:05:09 – 00:41:13:20
Speaker 1
Boy, I’m trying to remember this. Karen. Karen.

00:41:13:22 – 00:41:44:20
Speaker 2
It was really heartwarming thing to watch and see. And, Karen. Eventually she moved to another place, and it didn’t go quite as well. And I think a lot of that had to do with, you know, having the friendship, having your friendship and encouragement, having you checking in on her, really making her feel welcome and comfortable. And I think for anyone looking to potentially have a loved one move into a care home or a memory care setting, having that buddy system like, hey, who’s there?

00:41:44:20 – 00:42:05:14
Speaker 2
Who might relate to me, who might have an experience similar to me, who might be interested in kind of creating a connection, a bond, so that they can make that transition easier, that really we’ve used that model that you exemplified over and over again as people move into Marama, because it works so well when you when you were the one in charge, it was really great.

00:42:05:16 – 00:42:25:20
Speaker 1
Well thank you, I, I wish I could still have more of an image in my head, but, Yeah, I was thinking of when we did. We go to the zoo. I think we did. Yeah. And something like that was also an occasion to making sure that everybody was, you know, and.

00:42:25:22 – 00:42:34:21
Speaker 3
New attuned to women. I remember you, you kind of, I did try to mom,

00:42:34:23 – 00:42:59:11
Speaker 2
Everyone appreciates having a mom. David. Yeah. What is your experience as a son? What are some of the things coming up now? As you know, with your professional experience, your caregiving experience, your experience as a as a adult child, you know, where do you kind of see as the future of care for your mom, but also more generally for your patients?

00:42:59:14 – 00:43:01:20
Speaker 2
What do you hope to see?

00:43:01:22 – 00:43:28:17
Speaker 1
Well, it’s a great question, and I appreciate kind of the the dual roles that I have in terms of my professional hat versus my adult son role. And, you know, as a son mom, I feel really encouraged about how you’ve been home over a year. I remember when you moved back, that was, as is always the case, it was a big transition to change where you were staying.

00:43:28:19 – 00:44:00:11
Speaker 1
And I’ve actually been pleasantly surprised at how stable you’ve been over the last year. I know that, you know, day to day it’s easy to get caught up in the sense of feeling like you’re slipping, you know, figuratively or literally. But all things being equal, you know, Mike, maybe you can speak to this. I mean, when mom, when you moved back, it was kind of like, well, we’ll reassess in six months.

00:44:00:12 – 00:44:25:12
Speaker 1
We’ll give it a couple more years. And honestly, I feel like that’s still where we’re at, more or less. Can I tell you one important thing about when I came back? Yeah, I found people that I had known before I went, and I have friends who who stayed in touch with me, and I still stay in touch with them.

00:44:25:12 – 00:44:56:15
Speaker 1
And I think that’s important. People like me and and, the book group, the book group and and just our neighbors, I mean, we we’re not in a vacuum where we are. That’s that’s very helpful to know that I can call somebody up or do something together. So what I see, you know, as a, a son for my mom is really this hard reset that happened by living up.

00:44:56:15 – 00:45:32:17
Speaker 1
Marama has had lasting benefits back at home, where they’ve maintained the gains. And there’s a hopefulness that wasn’t present before. Having shifted the mindset from one of there’s nothing we can do. This is a one way, you know, downward spiral to more of, well, you know, every day is a challenge, but we’re up to the task because we have a toolset that is being deployed or used at the right place at the right time.

00:45:32:17 – 00:45:59:06
Speaker 1
I don’t know if it came through. Mike was mentioning that, he’s hired Elaine, a personal trainer at the local gym. And then in addition, they also have the chefs for seniors. And she’s going to a day program twice a week for two full days, which is turkey farming. That’s how I started my semiprofessional work in the field was being a care partner at a day program.

00:45:59:06 – 00:46:35:12
Speaker 1
So, you know, I know the value of these things, and they do take a not insignificant amount of effort and perseverance to keep going in the face of what is otherwise a progressive decline. The investment is not insubstantial. It has led to cutting back on things like travel, you know, other forms of discretionary spending. It is a budgetary stretch to invest in yourself this way, mom, but it’s to me, it’s paid off.

00:46:35:14 – 00:46:52:14
Speaker 1
Yeah. No, I, I agree, I, and we both, I should say especially like actually because of the dog, but I can’t run at all. And that’s really hard on me. And so I walk and we walk. And that’s just one other thing.

00:46:52:16 – 00:47:13:16
Speaker 3
There’s one, one other piece that I didn’t, I didn’t mention earlier, but twice a month we go to the, Alzheimer’s, support group for both. The both of both the client men and the ad caregiver. And, that seems to be helpful. I, I usually get a little nugget from some of the other, caregivers occasionally.

00:47:13:16 – 00:47:14:21
Speaker 3
So.

00:47:14:23 – 00:47:35:13
Speaker 1
Yeah, there’s one group of them and one group of us. And the ones that have us, they’re wonderful. Like, they know a lot. So that that is a good thing to, remind us. Yeah. Mike, you’ve been so, gracious, you know, sitting in the background there. But it’s really true without you, like our group, we’d be sunk.

00:47:35:13 – 00:47:41:07
Speaker 1
I mean, you’ve been doing the heavy lifting, for quite some time now, so take care yourself.

00:47:41:11 – 00:47:44:08
Speaker 3
Yeah, that’s me all over, so.

00:47:44:08 – 00:48:03:14
Speaker 2
Thank you. I was just thinking exactly the same thing. But you are really one of the heroes of this story. It does take a lot of work and that mindset. Right? It really is shifting from there’s nothing we can do to okay, I’m going to get in there, get my hands dirty and do everything I possibly can. It takes coordination.

00:48:03:14 – 00:48:25:01
Speaker 2
It takes prioritizing. It’s a huge amount of lift. And we’ve you know, just a second, what you said about the support group, we see over and over again that that’s profoundly helpful in reducing the burden of caregiving, just to know that you’re not alone, to be surrounded by other people, as you said, Mike, who can give you a tidbit of a resource, something that makes life a little bit easier day to day.

00:48:25:06 – 00:48:38:16
Speaker 2
It’s really impressive what you and Elaine have done together up in Sacramento. I really am so privileged to be able to share your story here on this platform, because I know it’s going to inspire so many others.

00:48:38:18 – 00:48:57:13
Speaker 3
But I think the normal really was the, was the kick off point for what we had to do, you know, and, yeah, they gave us a pretty good structure to try to maintain. Can’t do everything, but, but but we’re doing quite a bit of it.

00:48:57:15 – 00:49:20:17
Speaker 2
An impressive amount. That wraps up part one of my conversation with the delightful doctor David Merrill and his lovely mom, Elaine. In the next episode, part two, we’re going to take a deeper dive into the medical and professional side of the conversation, where Doctor Merrill will share his insights as a leading geriatric psychiatrist and brain health expert. I hope you’ll join us there!

00:49:20:19 – 00:49:53:17
Speaker 2
Subscribe so that you never miss an episode. Thank you so much for listening to the Think Well Eat Well podcast. If you enjoyed today’s conversation, please take a moment to subscribe, leave a review and share this episode with someone you care about. It’s one of the best ways to help others discover tools and inspiration for aging well. To stay connected, get bonus resources, and never miss an episode, head over to doctor Heather sanderson.com and join my email list.

00:49:53:18 – 00:49:58:01
Speaker 2
And until next time, keep thinking. Well, an aging on purpose.