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: Strokes/neuropsychological evaluations
As always, I have something happening to me. This results in having information for you. From my last article, I left you with the next step in my fight with severe vascular disease. This test was designed to reveal my strengths as well as my weaknesses. You may be scheduled for one and not know what to expect. First it is painless unless you think too hard with vascular disease and it results in headaches. Please, if only I had headaches I’d be filled with overwhelming joy.
My evaluation starts with:
Reason for Referral and Background Information: States reason for “why” they need one. Mine happens to be memory loss, misperceptions of events, brainstem strokes, seizures, vocal and motor tics, headaches and dizziness. Here’s another sentence about me having vision loss and fatigued that has to serve a purpose. I do experience “clonus” as well as spasticity. Cognitive issues and current memory loss are mentioned.
So the first part is why I am there for the evaluation. See, does not hurt unless you want to conceal issues and that would be counterproductive.
Medical History: Brings about a clear picture of what has transpired to bring about this visit. It lists my strokes and severe vascular disease. It also lists my current medications and dosages
Psychiatric Substance Use history: Not too painful physically. If you had even thought of suicidal type scenarios tell him. He shall ask. Be truthful for everyone’s good. I do not currently use any illicit drugs or smoke. I do not consume alcohol either. All of my current meds forbid the use of such.
Family/Social History: This reached deep into my soul and was difficult revealing. The edgy and jumpy that includes tolerating situations and environments was the easy part to reveal. This has been ongoing since my First 2 Brainstem strokes in 2006. Then I believe it hits the root of my issues with the reveal of “physical abuse” during my preteen years by a family adult. This has been in and out of reminders dealing with myself for years. Reveal it to the Doctor. Don’t think it will go away and it has no effect on your future life. It goes on to my education and GPA.
Methods of Assessment: Clinical Interview, Review Medical Records, Oral Word Association, Finger oscillation Test, Halstead Category Test, Hooper Visual Organization Test, North American Adult Reading Test, Personality Assessment Inventory, Rey Auditory Verbal Learning Test, Rey Complex Figure test, Trailmaking Test(Parts A and B), Wechsler Abbreviated Scale of Intelligence(WASI).
Behavioral Observations: This is what he sees while interviewing you. If you believe in Spirits, you might have some issues as you are dealing with a man of science. Motor tics and verbal tics are noted on the copy. I had some whoppers that day.
Test Findings
Intellectual Functioning: Well it’s nice to start off with a plus after revealing your abuse over 49 years ago. My Full scale IQ score is 122. This has not changed since 2006. All prior intelligence tests remain the same as 2006. Now here is a new medical term for me and I shall explain it. I was scored on a NAART. This is an estimate of premorbid intellectual efficiency. I had an estimate of full scale. Now premorbid was an ominous word for me. So let’s see what this means.
According to:
http://ajp.psychiatryonline.org/cgi/content/abstract/154/2/165
I had to read the bottom of this article where it spoke “English” for the common man. CONCLUSIONS: The results suggest that higher levels of premorbid ability are associated with greater pathophysiological effects of Alzheimer’s disease among patients of similar dementia severity levels. These findings provide support for a cognitive reserve that can alter the clinical expression of dementia and influence the neurophysiological heterogeneity observed in Alzheimer’s disease. So I guess I am a fish because I have full scales. Glub,Glub Sponge Bob.
Attention/Concentration: No changes since 2006. Now this is after my initial strokes. Is this bad or good? I’ll take no changes.
Visuospatial Functions: I have a segmented and inefficient constructional approach. In other words, I did the task but went about it the wrong way. My life story revealed for sure even before strokes. I can draw a clock. Tick-tock away.
Reasoning/Cognitive Flexibility: This measures performance on visual reasoning. I passed something.
Motor Functions: My dominant hand was above the average person. Reminds me of Yogi Bear, I’m faster than the average bear eh Boo-Boo. My left hand which is my affected side was a total reveal. I received a low average that being no surprise.
Language Functions: Verbal fluency solidly average. Thanks to Woodrow Wilson Rehab, as I was at ground zero when I had my strokes in 2006.
Learning and Memory: Immediate recall of noncontextual auditory/verbal information was low average. My visual memory with complex geometrical designs was severely impaired at both recall conditions. What can I say? Yikes comes to mind…
Personality/Emotional Functioning: The only reason I write is to provide my readers with up front information. This is why I promised to help others although it is difficult for me to “open” myself as to what goes on after a stroke to many.
I responded to items on the PAI in an open and honest manner sufficient to yield a profile of scores. The advantage of the PAI is that it assesses a broad range of psychological conditions, including anxiety, depression, mania, schizophrenia and some character logical disorders. It also has three normative samples including a census matched community sample, a psychiatric patient sample, and a college sample, which provides a broad basis for comparison. It also has four validity measures. The PAI subscales do seem to be especially useful for more detailed analysis.
All right here we go; I harbor significant concerns about thinking and concentration as well as somatic and physical health concerns. My test reveals some degree of manic symptomology and a significant depressive experience. It reveals I get involved in various activities in a disorganized fashion. Oh how true this is and I have hurt too many people who care about me.
This part also discovered that my suppression of childhood events carried on through my adult life. So there were things already present and all of my medical issues were a toxic mix of chemicals.
Summary Impression: I feel this is akin of an evaluation at work. You sprinkle in the good parts of the test then slammed on the bad. I should say “informed” as it is for my good, but still feel exposed. I am basically warranted for psychiatric consultation and psychotherapeutic “monitoring”.
Diagnosis Consideration: There are three considerations named Axis 1 through 3.
http://quizlet.com/5960525/axis-i-through-axis-v-global-assessment-functioning-gafscale-flash-cards/
Ruled out was being Bipolar.
Axis III was severe cerebrovascular disease.
He has made a request to my neurologist for medical intervention immediately. So my readers, there I lie exposed for you to see. I want to bring hope and understanding to those scared to see or request and evaluation. After you are evaluated with no lies…repeat no lies, you shall actually see yourself as you are or seen by others. Get the help you need. Try folks, never give up. Next article will be what transpires next.
Column by Chris DeWald
Chris DeWald: Strokes, vision and cerebral vascular disease
My world is turning out information for you as if you are going upstream with no motor. I figured not saying paddle as most have only one good working hand. First, what is cerebral vascular disease?
According to http://www.vasculardiseasesymptoms.com/cerebral.html:
Cerebral vascular disease refers to the brain abnormalities caused by diseases of the blood vessels that supply the brain. The most important cause of a cerebral vascular disease is hypertension. Due to hypertension, blood vessels deform, they become narrow and uneven which makes them vulnerable when the blood pressure fluctuates. Other risk factors are obesity, diabetes and smoking. A cerebral vascular disease increases the risk of suffering a stroke, especially in older people even though it can occur with younger patients as well, especially if they have a history of diabetes, heart disease and they smoke. However, strokes are not common in patients younger than 40 years old but the risks increase exponentially with the age.
The stroke is the result of a cerebrovascular condition and it occurs when a blood vessel within the brain is completely blocked or when these blood vessels rupture. Usually the blockage is caused by a blood clot in the cerebral arteries (also known as thrombosis). It may also be due to a an embolism, which means that the blood clot was caused by a piece of tissue, cholesterol or other several substances in the blood. When a thrombosis or an embolism occurs, the blood supply to the brain may be completely blocked or it can lead to blood vessels ruptures that will bleed into the brain. Both of these situations may result in a stroke. An embolism can cause a transient ischemic attack (or a TIA) because it blocks the small arteries in the brain which will cause losing the brain function in the specific area. After the blockage moves on and the blood flows again, the affected area of the brain will regain its functions. Dementia may be a result of a cerebrovascular disease due to the progressive destruction of brain tissue caused by repeated blockages of the arteries.
All right friends, those are the basics. The blood vessels get plugged with various junk and become smaller. In my case, genetics played a significant role in having smaller arteries in my head. I have been told since 2006, I am lucky to have survived at all and that this is a progressive disease. I do not have just one area they can stent but so many small paths that any operation will do not good. Yes it shall, I am here to tell you what happens.
At approximately 3 months ago, I started to notice my vision becoming unclear. I could see objects as usual, but I could not read the shows on my TV. Hey, a man and his remote control? Now we are in the danger zone. My usual visit, to the Neurologist, set a landslide of more doctors. But I am here to talk about vision today, so let’s focus on that. Did I type focus?
According to http://www.britannica.com/EBchecked/topic/199328/eye-disease/65013/Arteriosclerosis-and-vascular-hypertension:
The eye is the one structure in the body in which the blood vessels are easily visible to the examiner. Changes observed in the retinal vessels mirror changes that are taking place in other parts of the body, particularly those in the brain. In arteriosclerosis, degenerative changes occur in the walls of arteries that lead to thickening of arterial walls and narrowing of blood vessels and may give rise to complete occlusion (blockage) of a vessel. If the central retinal artery that supplies blood to the inner retina is affected, loss of vision is profound and sudden and, unless the obstruction can be relieved right away, permanent. Occlusion of the retinal veins is more common than arterial occlusion and also has dramatic effects caused by the damming up of blood in the eye. Blockage of retinal veins results in the bursting of small vessels, retinal swelling, and multiple hemorrhages scattered over the retina. Some degree of recovery of vision is usual but depends on whether a branch of the central vein or the central vein itself is occluded.
Profound and sudden I can see with my bifocals and with the screen at a higher degree of enlargement. It was sudden to me and profound. My vision is uncorrectable at 20/200 and my arteriosclerosis is visible to the “Medical Physician”. This is not a lens technician, but one who deals with diseases of the eyes. No matter what lens corrections, I cannot read with regular lenses. What does 20/200 vision mean?
Levels of Vision
20/20 – Normal vision. Fighter pilot minimum. Required to read the stock quotes in the newspaper, or numbers in the telephone book.
20/40 – Able to pass Driver’s License Test in all 50 States. Most printed material is at this level.
20/80 – Able to read alarm clock at 10 feet. News Headlines are this size.
20/200 – Legal blindness. Able to see STOP sign letters.
The point to remember is that the progression of this disease may reach your vision center and it is “quick” and profound. I can tell you, yes it is. One day, all clear. Next day “what’s on TV”?
You can follow me and this progressive disease as I was also sent to a neuropsychiatrist. Neuropsychiatry is the medical specialty committed to better understanding brain-behavior relationships, and to the care of individuals with neurologically based cognitive, emotional, and behavioral disturbances.
What is a neuropsychiatrist? A neuropsychiatrist is a physician (M.D. or D.O.) qualified to practice neuropsychiatry by virtue of either 1) primary training in psychiatry or neurology followed by a period of at least one year of fellowship training in neuropsychiatry/behavioral neurology, or 2) formal residency training in both psychiatry and neurology. Psychiatrists or neurologists with many years of extensive clinical, educational, and scientific experience in the field of neuropsychiatry may also merit this specialty designation.
Which patients are best served by neuropsychiatric consultation or treatment? The Neuropsychiatrist treats people with neurologic illness and cognitive, emotional, or behavioral problems; individuals with combined psychiatric illnesses and neurologic conditions; and individuals with atypical or refractory primary psychiatric disorders in which there is concern that an underlying neurological condition may be causing the “psychiatric” symptoms.
So, I am now at this level. Tune in next time, same Bat Channel…
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: 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
Filed under Blogs · Tagged with brain injury, cerebral arteriosclerosis, chris dewald