Saturday, February 25, 2012

Stoke continued

     Another problem with aphasic people is that they may not understand what you are saying.  Your voice might seem incomprehensible or sound like static to them.  If you think this is the case, your non-verbal skills will come in handy.  But, don’t make the mistake of believing that they understand everything, just because they smile or shake their heads when you talk.  Sometimes it is a good idea to test them by asking a question and see what their answer is.  If you say, “It’s a nice rainy day today” and they smile and nod to indicate yes, when it is actually sunny outside, you know that they are responding to the sound of your voice instead of your words.  Don’t overestimate their ability to understand you.
     If they really don’t understand you, they may get frustrated, irritated or uncooperative.  Many times a perceived lack of cooperation is simply because they don’t understand you.
     Keep your voice soft and steady.  There is no need to speak loudly; they aren’t deaf, they just have a problem understanding.  Of course, sometimes their hearing is affected.  Then you must speak loud and slow to make them understand.  You can assess their needs as you work with them.
     Even the simplest thing, like putting on a shirt, can be difficult for a stroke patient.  Stroke victims need positive reinforcement on a regular basis, especially when they try to learn something new, or work to regain their skills. That’s when they need you to tell them that they are doing fine, offering encouragement for each small success.  Give feedback right away---don’t wait until they finish the task before saying something.  Too much feedback is better than not enough
     I know that my husband was unsure of his footing and was afraid that he might fall.  When I put his physical therapy belt around his waist, I found it much easier to help him keep his balance.  A physical therapy belt is a strong fabric belt with a Velcro closure.  They are available through your local home health program.  If you don’t have such a belt, use a regular belt, anything that you can hold on to as your patient walks along.  It gives them the secure feeling that is needed while they practice their task.
To be continued.

Monday, February 20, 2012

Chapter 12 STROKE

     After my husband’s stroke, i knew that he would have problems using his arm and leg, but I couldn’t understand why he was so emotional.  He also kept bumping into things when he tried to walk, because his balance was poor.  There were so many questions about his condition, yet so few answers.
     I started doing research on stroke victims and found answers that helped me care for him.  When you understand what is happening to your patient, it makes it easier to tailor their care.
     After suffering a stroke there are often many behavioral changes.  Besides physical changes caused by brain damage, it was a surprise to see intellectual, emotional and behavioral changes as well.
     A stroke affects the brain by interrupting the blood flow to the brain cells, thus causing injury.  If the left side of the brain is damaged it affects the right side of the body and if the right side is damaged, the left side of the body if affected.
     All stroke patients are not alike.  It’s a mistake to think they are.  A stroke generally won’t affect all areas of the brain or its functions equally.  Each stroke victim will be different, depending on what part of the brain is damaged and the severity and type of damage.  Their recovery also depends on how recently the stroke occurred and their previous personality and behavior.
     While some parts of the brain will function normally, others parts won’t.  Your patient may seem as capable as ever when performing one mental task, but he totally unable to handle another task of seemingly equal difficulty.
     Of course, as with many illnesses, there will be good days and bad days, and even changes from hour to hour.  You should ask a lot of questions of the doctor to better understand the patient’s condition and treatment.  It’s hard to pinpoint all the changes that a stroke brings, so be alert to your patient’s needs and try to observe small behaviors so you can question the doctor about them.  It helps to write down your questions so you won’t forget.
     If there is left-brain damage, the right side of the body could be paralyzed or impaired.  People paralyzed on the right side, who are also right-handed are likely to have problems with speech and language, or aphasia.  The stroke victim may be able to understand what you are saying, but not able to speak or write to communicate.  Most aphasic people will have some trouble with both speaking and understanding.  But just because they have trouble speaking doesn’t mean that they can’t communicate.  Perhaps they can write their questions and needs on paper, or use gestures to communicate.  Experiment with different modes, using whatever it takes to keep in touch.
     Don’t isolate your patient; treat them as though they were functioning normally.  Talk with them as you are performing your duties, even though they may not be able to answer.  If they don’t understand your words, try using hand gestures or other forms of non-verbal communication.  If they use the wrong words, such as calling a cat “edak” or something equally strange, remember that they believe they are saying cat.
To be continued.

Wednesday, February 15, 2012

More about the end almost

     I went back to my little room to wait for Casey. The relief I felt when I saw my daughter’s face at the door of my little room was overwhelming.  We hugged me tight and the tears came again.  I knew that with her by my side, I could face whatever was coming.  Our granddaughter, Nikki, came with her mother---she wouldn’t stay away.She loved her grandpa.  She started to cry as well, frightened by our tears.
     I took Nikki and Casey back to see Wayne.  He was still unconscious, but Casey and I took his hand and squeezed it.  Casey talked to him and held his hand tight.  Finally, after what seemed like an eternity, his eyes started to open.  He saw me and Casey and tried to talk, but the tube down his throat was pressing on his larynx and he couldn’t make a noise.  We explained to him what had happened and he seemed to calm down a little.  We stayed for a short time and then had to leave.
     Nikki took her great-grandmother out to lunch and Casey and I talked with some friends who had stopped by to see us at the apartment.  After we knew that Wayne was stable, we too, ate some dinner.  My appetite was small, but I hadn’t eaten all day and I knew it would be a long night.
     After we ate, we returned to see him again.  The nurse said his blood pressure was staying up and we could rest easy tonight.  She would call us at the apartment if there was any change.  It was a restless night for all of us.  We finally told my mother about Wayne’s condition, now that we were sure he was stable.
     As I lay on the bed in the overheated apartment, I found it hard to control my emotions.  I wept, my mind full of questions about Wayne’s condition.  What am I going to do?  When I take him home, what will his prognosis be?  Is he going to be functioning?  Will he make it?  I couldn’t bear to be without him.  It’s strange how everything in your life can change in a heartbeat.
     What a dreadful time that was...I don’t want to go through that ever again.  Needless to say, he kept his colostomy, for the time being anyway.  No more anesthetic until he was better able to handle it.
     In times like these, you need family and friends to help you through.  It is too difficult to handle experiences like this alone.  Emotional support is vitally important.  Whether it’s family, friends, or your pastor, you need support.
     There are also many support groups.  Be sure to check with your hospital to find the support you need.  If there is not a support group in your area, start one.  You will find that there are many people in your community who also need help and support.  Your hospital Social Service worker will give you the help you need to get a group started.
                                 Thought for the Day
                     I have been driven many times to my knees by the
                    overwhelming conviction that I had nowhere else to go.
                                                         Abraham Lincoln

Sunday, February 12, 2012


     About four months into Wayne’s illness, he began to regain his strength and was able to walk a little  He was eating and gaining weight, but he was constantly complaining about  his colostomy itching so terribly.  We discussed this with the doctor and he said that we could reverse it or keep it, whichever was best for us.  We talked with all the doctors that would be working with him if we reversed his colostomy, and they decided to take him to surgery and reverse it for us.
     Soon after Wayne entered the hospital to have his colostomy reversal, the staff began cleaning out his intestines to ready him for surgery.  After pleading with Wayne for an hour, he finally drank the briny solution that was required to do the job.  It was about as unpleasant as anything I have ever tasted.  Yes, I tasted it just to understand what Wayne was going through.
     Wayne’s colostomy bag was removed to give him an enema directly into the exposed intestine or stoma.  However, the nurse didn’t get it back in time.  You guessed it, the enema began to work and the flood was on.  What a mess.  I rang for the nurse and tried to contain the overflow to the bed with paper towels and washcloths.  A call was put in to Bridget, the enterostomal therapy nurse.  She brought in a unique bag to attach around his stoma.
     It was a con-shaped bag, about twenty-four inches long, with a “zip lock” top and a clamp on the bottom.  She glued on the base as usual, then attached the long bag with a top that closed like Tupperware, It was a good fit.  Now, when the nurse had to give him more Fleets enema, she could simply open the zip lock top to administer the liquid and open the smaller end to release the waste.
     Pretty ingenious, I’d say, and the bag held a lot so the nurse didn’t have to come in to check it too often.
     You can learn a lot by watching the nurses in action and by asking many questions.  When the nurses know you are interested, they will take more time to explain every procedure to you.  This will give you the opportunity to become involved in every aspect of your loved one’s care.
     Wayne was ready for the reversal of his colostomy and he went into surgery the next morning at 7:30 a.m.  As the anesthesiologist began giving him an epidural block, his blood pressure dropped to twenty and his heart stopped beating.
     The surgery team thumped his chest and started CPR.  Finally his heart began to beat again.  The doctor came out to tell me what had happened, then ushered me to the cardiac unit and led me to a little room by myself.  I knew the situation was really bad when they put me in this little room reserved for families of critical patients.
     The doctors worked on him feverishly.  Wayne’s blood pressure had dripped back to twenty and heart stopped again and again.  This went on four more times before they got him stabilized and administered medication to return his blood pressure to normal.
     It’s strange how a man who had always suffered from high blood pressure, which caused his kidney damage in the first place, now had blood pressure so low it stopped his heart.  The doctor came out to see me, telling me his condition was touch and go.  The next few hours would be critical.  If his blood pressure stayed up, he had a chance; if not we were going to lose him.  He could die! Actually, he did, four times already.
     I struggled to prepare myself for the worst.  I told myself it might be for the best--if he had been without oxygen for too long he might have suffered brain damage.  However, I couldn’t convince myself of that.  I was panic-stricken.  There was no one to talk to.  If I told my mother about Wayne’s condition, with her bad heart, she too could have a heart attack.  She loved Wayne like a son.  I tried to be strong and I think I might have made it if I hadn’t called my daughter to tell her of her father‘s condition.  That’s when I lost it.
     The tears were rolling down my cheeks when I told her the worst might happen.  Until then I was holding it together, but somehow putting it into words brought it home to me.  I broke down and cried with fear.  Fear of losing the man I had been married to for forty-five years.  I wondered how I could handle all this alone.  I wished that Casey were there with me.  I sat in that room, alone with my thoughts, for what seemed like a lifetime, remembering all the good times in our marriage, our children, our life, all the times we needed each other.  Now I might not have him to share any more good times.
     Casey was packed and ready to go to a golf tournament when she answered my call.  She dropped everything and broke all the speed limits traveling the 168 miles from Boardman to Portland.
     Not long after I talked with Casey, Wayne’s doctor escorted me to the cardiac critical care unit.  Wayne lay on sterile white sheets, his color as grey as death, with IV’s trailing out of both sides of his neck and arm.  There was a tube down his throat and into his lungs that was breathing for him.  The nurse suctioned fluid out of the tube from time to time.  His hands were tied to the bed, so he couldn’t pull at the tube and IV’s and he was unconscious.  He looked so helpless, so vulnerable.  Tears rolled down my cheeks, as the nurse put her arm around me to comfort me.
     Bridget, the enterostomal therapist, came in to change his colostomy bag.  She was surprised to see Wayne’s condition, when she had just wished him luck the night before.  When she hugged me I felt tears once again.
     He started to choke and I could hear his chest rattle.  I thought of the death rattle people talk about, wondering if this was going to be his last breath.  I was afraid if his heart didn’t fail, he might die of pneumonia with his lungs so full,  I took his hand, but there was no response.  I had to leave when they were suctioning out his lungs again.  I couldn’t take it.