Charlie took a fall several weeks ago but seemed to have no ill effects until several days later, when he began to complain that he couldn't raise his left arm. I encouraged him to keep working with it, in hopes that the problem would resolve itself. The arm was not painful, so he didn't complain about it, but his dementia allowed him to forget that he was supposed to work with it. Instead, he just quit using it altogether.

This went on for a few weeks with no improvement, so I finally made an appointment for him to see his doctor at the nearby Veteran's Hospital.An x-ray of his shoulder showed no fracture or dislocation, so he was referred to the physical therapy department for an evaluation. They determined that he had a "frozen shoulder" and sent him home with a set of pulleys and instructions to use them three times a day.

Charlie is the type who wants an instant cure for any physical problem that arises. He thinks there should be a pill for everything. So he was lackadaisical, at best, in performing the daily ritual. I constantly prodded, but he always wanted to put the exercises off, promising to do them later. Needless to say, when he went back to the doctor for a follow-up, there was no change in his condition.

The suggested solution was to have Charlie see a therapist once or twice a week for supervised physical therapy. We elected to go to a private practitioner for the treatments because the office is more convenient.And so we began treatments that have now been ongoing for over a month, with only moderate improvement in the condition.

Of course, their instructions included Charlie using the home pulleys in between visits and that just hasn't happened.

He can now raise the arm about parallel to the ground but no further. So the dilemma has become: Do we continue therapy through the upcoming winter months or do we call the progress good enough?

He has no pain and never complains about not being able to use the arm fully. But of course all he really has to do is dress himself and push his walker around. Since he has no problem doing either, he is begging me to quit taking him to therapy.

I know I will feel guilty if I give in to his request. I also know that Charlie, in his right mind, would be working very hard to recover full use of the arm. But I am not sure it is worth the battle to insist that he continue a treatment that he wants to stop.

I understand his reluctance. A visit to any practitioner usually means a shower and shave, chores that have become difficult, exhausting and distressing for him. He also has trouble walking from the car to the treatment room with only canes for support. The walker that the Veteran's Hospital provided him is large and clumsy, making it hard for me to load into the car. I have also noticed that he is exhausted when the sessions are over.

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The question came up again yesterday. Charlie had a follow-up appointment scheduled with dermatology to check for any suspicious skin lesions. He refused to get out of bed in time to keep the appointment. When I called the office to cancel the appointment the question of rescheduling came up. I made the decision to not reschedule. It isn't fair to the medical staff to keep cancelling appointments when a reluctant patient digs in his heels.

So what's a caregiver to do? When do we call a halt to all the measures that the medical community suggests? Do we just keep our loved ones comfortable and diminish their agitation as much as possible?

It's one of the biggest dilemmas we face as the brain drifts deeper and deeper into obscurity.