Chris DeWald: Psychopharmacologic management and stroke survivors
An article was posted on AFP on Oct. 16 in regards to my travels down the road with medications. This is a followup and what has happened since this date. What is this article about? The first word looks too large and complicated to want to read any further.
Getting your medications correct for your survivorship is important. Most of us have multiple doctors that may not be in communication with one another.
OK, what the heck is psychopharmacologic management? Besides being a tongue twister? The program provides answers to difficult behavioral health pharmacy challenges, including medication non-adherence, contraindicated prescriptions, supra- and sub-therapeutic dosing, and other problem prescribing patterns. Read more
Chris DeWald: Strokes and friendships
So many items around you when you have your first stroke go astray. Besides physical inabilities to conquer, you have to face true friendships and future friendships. What did I just say? When I had my strokes in May 2006, I discovered that people I thought were my friends distanced themselves from me. From what I hear from my “new” stroke friends, this has occurred to them when met with a deadly life-changing event.
What is the common root of this loss of close friends? I feel friends in sheep clothing cannot withstand being around people that are ill, or have changed. Some of our physical attributes changed and are “ugly” to some. The clenched fist from the muscles getting atrophic; muscle tone tighter than a mosquito’s rear end looks unusual to those seeing it for the first time. Angry pathetic words are made up like lobster boy and claw man for this condition. Their IQ might be superb, but outward appearances derive negative connotations.
According to
http://onlinelibrary.wiley.com/doi/10.1111/j.1460-6984.2011.00079.x/abstract:
Outcomes and Results: 29 participants were recruited of whom 10 had aphasia. The main reasons given for losing friends were: loss of shared activities, reduced energy levels, physical disability, aphasia, unhelpful responses of others, environmental barriers, and changing social desires. The subset of participants who experienced the most extensive loss of friends were those who described a sense that they were closing in on themselves leading to a withdrawal from social contact and a new preference for meeting only close friends and family.
Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke. The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity-based, and where the participant had a ‘friends-based’ social network prior to the stroke.
I would score this high. I feel there are more direct causes. Fear from your ex-friends is one. The article above should be laced with “Son, you have had a brain injury”. Once we understand that the “brain” injury caused the above, we have a basic start. Here comes the negative connotation again. Since he has a brain injury, we sometimes get lumped into being “less” intelligent. I have been trying to get employed at a menial part-time position. I see prospective employer’s looks and I feel the. I’m sorry…you appear “stupid,” or other words associated with being mentally inefficient. I scored high on all their employment exams, but never get called. I see others getting jobs, but not me.
All right, we have had a brain injury. As survivors, we need a social group/club to express our concerns. You shall find many of your best friends are now stroke survivors. Why? They have been “there.” Their failures and triumphs are shared and you learn from mistakes and also productive successes.
Now, have you changed to warrant friends leaving? Since my injury, I have tried to compensate my weaknesses in the wrong manner. I lie to myself and then it transfers to others. Failure to accept the “new” you can lead down the wrong path of life. Be knowledgeable and understand what is going on now. One of my issues was I was on the wrong medication for six years. I was being treated for depression from day 1 of the brain stem strokes. I was not depressed. The pieces missing in my injury was needed to have a mood suppressant. I was not depressed. The wrong medication turned me down the wrong path. If you had issues before, the wrong med can intensify your mode of operation.
So without help, you do what you believe is the answer to everything in your new life. No direction is prominent and you suffer as well as others. I had a devastating result to me handling things without help. I am so happy it was found and is now being treated responsibly. But your past of doing weird things for six years takes its toll on you and others. When do you stop saying sorry? When does “sorry” become a word that no one believes anymore.
Kim Anderson, from Irvine, Texas, tells me the following:
Most friends desert us after a stroke because we are not the same person we once were to have fun with. I have had a true friend for over 30 years, she has been there for me through thick and thin, when my youngest was born, my stroke and when my hubby died. No matter the circumstances. Now that is a true friend, she doesn’t treat me any different either. not one we thought were our friends, those were just acquaintances I think a lot of people don’t know how to act around us after we have a stroke or what they can do to help, they realize their own morality maybe.
Family members even have a hard time in knowing what to do around us. No one really does, I guess, unless they have walked in our shoes, no that is it in a nutshell.
Kim is a survivor, and I am indeed proud of her. Although she is a Cowboy fan and her other stroke buddy is a Steeler fan. I find them to be very intelligent, funny and strong willed.
Now we have an insight on the personal feelings and one type of anguish felt by survivors. If you are a friend, help yourself to understand. Help your friends to understand. It is a two way street. True friends are forever. Thanks, readers.
Column by Chris DeWald
Chris DeWald: Stroke and emotional changes
Hello, my friends and also my religious enemies. What a way to start an article besides with friends. Seems I made some religious enemies from my article on melanoma, and my immediate reaction was not favorable. That shall be revealed later, but is relevant to how we as stroke survivors deal with complex emotions.
According to one source, http://www.paxilprogress.org/forums/showthread.php?t=20421
What is Emotional Lability?
Emotional lability is the term used when someone is more emotional and/or has difficulty controlling their emotions. It can happen with many neurological conditions and often happens after a stroke. Some people describe feeling as though all their emotions are “much nearer the surface” or more exaggerated after their stroke. For example some people may become upset more easily, or cry at things they would not have cried at before their stroke. Their emotional response is in line with their feelings, but is much stronger than before the stroke. For other people the symptoms can be more exaggerated, and some people find that they cry for little or no reason. Less commonly, people laugh rather than cry, but again the emotion is out of place and does not match how they are feeling at the time.
What causes emotional lability?
Emotional lability is caused by the damage done by the stroke. Chemical changes within the brain can cause psychological and emotional changes. Frequently, difficulties with swallowing and tongue movements coincide with emotional lability. If this is the case a Speech and Language Therapist may help to accurately identify emotional lability.
Here I am again !!! Now that I just provided you one term, the following information is more prevalent. http://www.tree.com/health/stroke-emotions.aspx
Surprises Stroke Emotional Aspects: Depression, Anger?
Having a stroke causes emotional difficulties for both the patient and family members. Anger and anxiety are common responses to the permanent limitations and loss of independence caused by a stroke. Further, the slow and sometimes tedious pace of rehabilitation can cause lack of motivation that, if left unchecked can develop into depression.
This is not just out of facts, I had it. The anger was mean and powerful. Being told I could not be employed anymore at 50 years old was impossible. Being told I was lucky I was saved for a reason and should be dead was not a compromise. Telling yourself, This was not true, and in a week all will be well, did not come about. I confirm the first part of this article.
Personality Type and Stroke
Surprisingly, personality type plays a large role in stroke rehabilitation. People who react well to stress, control anxiety, and are generally optimistic about life before a stroke are most likely to react well to life after the stroke. People whose personality type makes them prone to anger, anxiety, or depression, or who lack motivation usually find stroke rehabilitation difficult and discouraging.
On the other hand, personality type is vulnerable to change after a stroke. While any stroke victim is at risk of depression, sudden signs of anger, anxiety, and uncontrolled crying in people who were previously adept at handling stress may indicate that the stroke has caused a personality change.
Lack of Motivation and Signs of Depression
Stroke rehabilitation can be slow, painful and frustrating. When stroke survivors do not see the improvements they hope for, they are more likely to lose motivation. Lack of motivation is a normal reaction to setbacks. However, when a lack of motivation persists and impairs progress in rehabilitation or if the lack of motivation spreads to other areas of life, it may indicate depression.
Signs of depression in stroke survivors should be reported to health care professionals as soon as possible. If depression is left untreated, stroke survivors may become suicidal.
Signs of depression include
•lack of motivation
•increase or decrease in appetite
•sadness
•fatigue
•memory difficulties
•personality changes
•sexual problems
•suicidal thoughts
•insomnia
•feeling “hopeless
Now, this list is fine, I feel, as a general rule. But as a “stroker,” I did not have lack of motivation. I wanted to get back to work … and you, as a stroke survivor, will get busted by a neuropsychologist if you try to lie yourself on a work release. I did lie, and that is not good. An Increase or decrease of appetite occurs? Hello, hospital jello stinks. Had a brain stem injury? Enjoy liquid IV fluids. Have sadness? Really? You just lost half your body somewhere. You can see where I am headed. I feel these are normal serious stroke reactions. So bring them anyway to your physician’s attention. Tell your caregiver, they need to know from you.
Anger, Anxiety, and Depression in Caregivers
Anger, anxiety, and signs of depression are common in caregivers as well as stroke patients. The restrictions and changes to routine and family life can cause frustration and anxiety in any family member. A stroke patient whose personality tends towards anger and depression, or whose personality changes radically, can leave caregivers feeling angry and resentful. This anger at times turns into guilt (“How can I be angry at him? He’s the one who’s sick . . . “), which can result in increased stress and depression.
See that, caregivers. You deserve a hand and lots of praise.
Time To Share
They mystery feelings I had when I began this article shall now be revealed. I was not the only one to be singled out by a person or people that I now forgive. I thought you readers should see what is out there as food for thought.
There was this first strike at me. I want to warn the readers. The article can be highly offensive. It contains pictures that may be offensive. It also contains racial hatred.
http://collectiveunderground.wordpress.com/category/chris-dewald/
They even photoshopped my melanoma.
Was I alone? The answer is no, and they struck out at a deceased young lady also.
http://andgodmadelight.blogspot.com/
This stroker went through all the emotions mentioned. I contacted via e-mail every form of government, state and federal, as I felt that no person should be subjected to this agenda. Tax-exempt status? Good Morning, America … I love you, readers, and I do forgive them. I just wish the government had a set.
A set of what? Sorry, I am a forgiving man.
Column by Chris DeWald
Chris DeWald: Recurring strokes
It is so good to be back to writing articles. Nothing had happened to me to write about until April of this year. I had not been feeling well for about three months leading to April 2011. My blood pressure was out of control in elevation and also in sudden drops. It was necessary for me to see my General Physician once a week to attempt to regulate it. One visit turned into a setback. My body talked to me and I fell out at her office. All said and done, I spent a week back at Augusta Health with another stroke. So let’s explore this. Caregivers and survivors alike need to just be aware of this.
According to www.stroke.org/site/DocServer/NSAFactSheet_RecurrentStrokerevised.pdf?docID=998:
After stroke, survivors tend to focus on rehabilitation and recovery. But, preventing another (or recurring) stroke is also a key concern. Of the 795,000 Americans who have a stroke each year, 5 to 14 percent will have a second stroke within one year. Within five years, stroke will recur in 24 percent of women and 42 percent of men.
Having one or more of these factors doesn’t mean you will have a stroke. By making simple lifestyle changes, you may be able to reduce the risk of a first or recurrent stroke.
These simple lifestyle changes can greatly reduce your chance of having a stroke:
Control your blood pressure
Find out if you have atrial fibrillation (an irregular heartbeat that allows blood to pool in the heart and cause blood clots)
Quit smoking
Limit alcohol
Monitor your cholesterol levels
Manage your diabetes
Exercise often
Eat foods low in sodium (salt) and fat
Monitor circulation problems with the help of your doctor
Gee, right off the top we see blood pressure. Now I don’t want you to be afraid of living. Yes, strokes are a scary life changing event. They often end up with disabilities and a hard journey for any recovery no matter to whom. My first ones took place in the brain stem. I had two at once on each side of the brain stem. I did not just one being alone in my head. It is lonely up there.
This recent stroke took me through situations I had forgotten. Laying on the gurney in the ER and not caring about IV insertions. Not me for sure in that respect. Getting run to the CAT scan and getting sick from any type of movement. Just lying there and being pushed caused such horrible vertigo. I did not care about the MRI scan and being claustrophobic. My words were slurred again, my left side went on a vacation somewhere and I wanted my world to end.
Yes, I admit that my initial feelings were “no more,” how long do I have to fight you, Mr. Stroke? I was lucky again. Within two days, I regained my voice and my ability to walk. I had to fight and I did not want to give up after regrouping my thoughts. My motivation was the hospital Jell-O. I was not staying there for that anymore. When I left, I had the clonus again and the spasticity returned to the status of my first mean strokes of 2006. That has cleared up from physical therapy. My left arm has become the victim of having less power. My left hand is still numb and I can’t find the re-boot button for my hand…LOL.
I told you about me and getting depressed because I believe it is a natural thing to do. If it is justification for me on the way I felt. Granted … But I left my Superman tights at home that day … Yikes, erase that image, OK … It is what you do next when you know you are getting depressed that counts … Now, I may be that exception to the rule because I do have severe cerebral arteriosclerosis.
In other words, I am hard headed (lol) with limited blood flow supplying my brain the nutrients for survival. So this does not mean you are going to have another stroke in five years. The statistics from a good organization are not made up. I do not drink, smoke or have issues with my cholesterol. I was having issues leading to this controlling my blood pressure. The brain stem controls your heart and breathing rates and I believe this sign was warning me.
People that have had strokes, don’t let that monster get you. Oh, it bites and leaves scars. Just bite back harder. See you readers next time.
Column by Chris DeWald
Chris DeWald: Stroke deficits – the gifts that keep on giving and giving and giving
Hello, again. I am going to introduce you to another stroke survivor. I feel another voice would be beneficial to survivors and also caregivers.
Donna was the first stroke survivor I had met online that was a base of information for survivors and caregivers on strokes. Not from doctors, but from someone who shared your same path. This allowed me to feel that I was not alone. She gave me inspiration to keep going and played a major part in my decision to write. Without further ado, allow me to introduce Donna.
Hello, Readers; my name is Donna, and I’ve been a stroke survivor since 1-1-05. My stroke deficits include spastic hemiplegia. This means that one side of my body was affected by the stroke. In my case it was my entire left side.
After six years, one would think that over time, my body would have stabilized and I would be more apt to getting up from a sitting position independently. Not so fine, friends and readers. My experience has been that my deficits decide to act up and cause me embarrassment and a source of laughter and entertainment to myself and those around me. The saying regarding “Murphy’s Law” happened in real life to me as recently as this past Saturday (4-1-11) when a attended a 1-year-old’s birthday party.
I thought my only challenge would be gaining access into the home as there are open steps and no railings. That challenge I succeeded at with help from my daughter and friends. Once in the home, I parked myself on the sofa where I would be out of everyone’s way. No, I did not sit on the right side of the sofa against the armrest. I had to pick the left side, which of course meant that I did not have usage of my left arm/hand to stand up.
After a period of time, I decided that it would be better for me to sit in the dining room on a solid chair rather than the soft and low to the floor sofa. When an arm was extended to me to help me get up, of course I said, “I can do it. No thanks.” I haven’t revealed to you that I am a stubborn, bullheaded Irish/German/English gal, so of course I didn’t want help. I pushed off with my right arm and got elevated about six inches, and my bad leg gave out and I plopped back on the sofa. After three more attempts on my own, my daughter heard laughter and came to see what was going on. She, on the count of three, pulled me up. Once again my bad leg gave out and down I went onto the nice soft sofa. By this time I was really attracting attention as others came into the room.
It was then decided, if someone was on my left side and someone on my right side, they’d pull me up at the count of three. I was helped up into a standing position; however, my left side decided it liked the sofa – again and down I went pulling the person on my left side down with me. By this time I and everyone else were laughing so hard we had tears. Thankfully the camcorder was not running, nor were any pictures snapped.
Eventually I was assisted, and walked unaided to the chair waiting for me in the dining room.
Geez…..maybe I need standing up lessons from the 1-year-old little boy, haha.
Column by Chris DeWald
Chris DeWald: Stroke-severe arteriosclerosis, Part II
It has been three weeks since I have been taking an old medication called pentoxifylline. My first article about this subject centered on me and what was happening to my body as a result of this disease.
To recall some first concerns as to why I do not go the route of surgery is important. I am not a surgical candidate as all my vessels carrying nutrients, oxygen and fluids are so severely clogged, there is no beginning or end. This reminds me of Marty Feldman playing” Igor in “Young Frankenstein” substituting a brain with “Abby Normal.”
According to the National Institute of Health, pentoxifylline is used to improve blood flow in patients with circulation problems to reduce aching, cramping, and tiredness in the hands and feet. It works by decreasing the thickness (viscosity) of blood. This change allows your blood to flow more easily, especially in the small blood vessels of the hands and feet. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Please note, pentoxifylline controls the symptoms of circulation problems, but does not cure them.
Other uses for this medicine
Pentoxifylline also is used for leg ulcers, strokes, high-altitude sickness, eye and ear disorders, and sickle cell disease and to treat pain from diabetic neuropathy. Talk to your doctor about the possible risks of using this drug for your condition.
First, I was having issues with what is described as the loss of blood flow upstairs in the cranium. My vision was fuzzy and I had severe pains that lasted maybe 15-30 seconds from on top of my head as if someone was drilling for brains. If they were brain eaters, they starved for sure.
Now, again, for me as the patient, I did not have as many as the side effects as noted. The first was a concern that it would further thin my blood as I am on warfarin (coumadin). Warfarin is a medication that thins the blood reducing the possibility of further clots. Pentoxifylline was mentioned on other websites for doing this also. This did not occur. Three weeks post, and my pro-time and INR stayed the same.
Please take me med with more than a cracker. When it says with food, it means with food. When I “crackered” it, I did have some stomach issues. Flatulence was another item mentioned. I am of the male variety, so I could not tell. Headaches were another possible side effect. I did not experience any other than I already had. I was and still am taking three pills a day each with a 400-mg dosage.
My benefits
Three weeks post, my vision has become clearer. The fuzziness around the letters has more clarity. I have more time and the ability to do more with my mind than before. Now this is not much as it is only three weeks. It is noticeable as I do no nap as long as I did before. The drilling devices on top of my head looking for brain material have ceased. I do not have those debilitating pains.
I used 3 vocabulary games to try and exceed my previous scores. I also have three mathematics testing games. All are timed to obtain a score. There is no change, so I guess this is part of the brain that disintegrated.
So in conclusion, I feel this medicine is allowing more oxygen into the capillaries by creating more flexible red blood cells that can squeeze between the barriers of scale and cheese fry grease. My vision is clearer, and my headaches on top of my head are gone so far. Now every patient is different from the next. Willpower, other medical conditions, may not make you suitable for this drug. It does not hurt to ask. This is far gratifying than not having tried this medication. I was going downhill faster than I wanted to, but this gives me more time on this planet to write for you. My friends.
Column by Chris DeWald
Chris DeWald: Strokes and vision
Posted by afp on April 13, 2012 · 2 Comments
According to www.ninds.nih.gov/disorders/cerebral_arteriosclerosis/cerebral_arteriosclerosis.htm, cerebral arteriosclerosis is the result of thickening and hardening of the walls of the arteries in the brain. Symptoms of cerebral arteriosclerosis include headache, facial pain, and impaired vision. Read more
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