Posted by: dlip | September 24, 2014

Skincare after a Stroke

This was read on the website of the Rehabilitation Institute of Chicago – Nursing Practice Council. I thought that certain aspects of it would be useful to share.

After experiencing a stroke, patients may be at risk for skin problems due to decreased movement and feeling. Several types of skin problems can occur:

Sores, blisters, rashes or skin color changes may develop if someone remains sitting or lying in one spot for long periods of time.

Loss of feeling may affect ability to notice contact with something sharp or hot.

Bladder or bowel accidents are special concerns because they can cause the skin to become irritated.

Older people tend to have greater skin problems after a stroke because skin becomes less elastic with age.

Keeping Skin Healthy

Healthy skin is intact, well lubricated with natural oils and nourished by a good blood supply. Skin stays healthy with a balanced diet, good hygiene, regular skin checks and pressure relief. Relieving pressure and checking skin ensures a good blood supply. Skin problems can often be prevented. The following tips will help.

 Hygiene

Keep skin clean and dry. Urine, sweat or stool can cause skin breakdown. Bathing every day in a tub or shower may not be necessary and may also wash away natural oils that lubricate the skin. A daily sponge bath, however, is good for exfoliation of dry skin and overall personal hygiene. Always try to keep palm side of affected hand and underarm clean.

Dry well after bathing, but avoid hard rubbing with a towel – it can hurt the skin.

Back rubs can be very relaxing, but should be done with lotion or oil, not alcohol, which is very drying to the skin.

Trim nails regularly and avoid sharp edges or hang nails.

Individuals with diabetes should do self foot care examinations and see a podiatrist regularly.

Nutrition

Eat a healthy diet. Protein, vitamins and iron are especially important. Consult with a nutrition professional for help planning a diet that will meet your needs.

Drink six to eight cups of fluid every day.

Tube feedings are chosen to provide all necessary nutrients.

Pureeing or chopping foods does not change the nutritional value.

Skin inspection

Check skin regularly to spot sores when they are just starting.

Inspect entire body, especially bony areas (see illustrations above).

Check at least twice a day – morning and evening – when you change position. Check more often if increasing sitting or turning times.

Check skin every hour when using new equipment.

Do not depend on others to tell you how your skin looks. If you need help, however, clearly explain what warning signs to look for.

Use a long handled mirror to help with hard to see areas.

Be alert to areas that have been injured and healed. Scar tissue breaks down very easily.

Look for red areas, blisters, openings in the skin or rashes. In red areas, use the back of your stronger hand to feel for heat.

Do not forget to check groin area. Men who wear an external catheter should check genital area for sores or other problems.

Posted by: dlip | March 16, 2014

Information about preventing a stroke

Although this is something I’ve taken off an email sent to me about a week ago, I feel it is relevant enough to place here.

As always, a caveat: This is hearsay and is no substitute for getting a check up from a doctor. But they could be warning signs and after a certain point in life, or if your lifestyle could predicate a stroke, this is worth reading.

Before we get into the details here is what the emailer said happened to him:

“Three years ago I was struck down by a stroke. Three years later I am still stricken with the malady. In the beginning, I asked doctors about the condition and was told that there is no cure for stroke.  I asked about the symptoms and was told there are no symptoms meaning a stroke will attack a person suddenly, without warning. That is bad news, very bad news.

I did not believe that.  So, I thought back to my experiences and I found that there are plenty of signs that a person is susceptible to an attack of the deadly stroke.

If you cannot cure it at least you can prevent it. We must choose to avoid the stroke or be condemned to consuming tons of pills whose veracity is questionable. How do we go about that, how can we prevent stroke. Will it be expensive?  Will it be time consuming?

Before we go into details let us first recognize the symptoms, the signs if you like.

More than thirty years ago, while reversing my car, I suddenly found that I could not move my right leg. It simply refused to obey me. I went to see a doctor immediately and all I got was two days medical leave. That was the first sign that I was heading for a stroke. After two days rest, I was back on my feet as if nothing had happened. I just put it down to work stress and physical and mental exhaustion. When I was afflicted with the stroke and certain parts of my body refused to obey me I realized that I had experienced that feeling before.

I will now endeavor to put down, for you, the other signs so that you may recognize a potential victim before the stroke strikes and be able to take evasive steps to prevent it  happening. These signs will be presented  randomly as they come to mind. 

Let us first recognize the symptoms or the signs if you like.

1.  When walking you stumble even on  level ground.

2. You kick the legs of chairs and tables when you usually walk pass them effortlessly, because your legs are not as strong as they used to be although you do not realize it.

3.  You sometimes find you  cannot pronounce the ‘ar’ sound and it comes out as ‘el’, your speech is slurred and sometimes you drool.

4. The pen you are holding slips from your fingers. Holding up the newspaper can be a problem because your fingers have lost their flexibility. You think it is clumsiness when in truth it is not. It is caused by your muscles having lost their strength.

5. After sitting for some time you find that you cannot stand up as usual. You lose your balance and fall back onto the seat.

6. You also lose your balance when you squat and may find yourself sitting instead of standing up.

7. You are always sleepy even after a good night’s sleep. This sleepiness is quite different from the usual tiredness you experience after a restless or late night.

8. Urinating has become a problem. Instead of a strong stream what you get is a trickle and this causes you to go to the toilet often.

9. Constipation becomes more frequent as your rectal muscles do not work well anymore.

10. Sometimes you will find you are forgetful and  mental activities become difficult as your brain weakens through lack of nourishment. Blood is not getting through to your brain quickly enough.

Some of these signs will come and go, so you do not take them seriously when they do occur. You pass them off as signs of physical and mental stress or aging.  Since there is no pain you do not think it necessary to see a doctor. The signs come on only momentarily and disappear almost at once. So you think it is nothing serious and seeing a doctor is out of the question, until it is too late that is. Then, it is the doctor who has to come to you.

Also, the signs are similar to many other diseases and illnesses which are quite common. And so you think that seeing a doctor is rather pointless, as far as a stroke is concerned, as you would describe the symptoms you are experiencing only at that particular moment.

But be aware and insist on a check up and start taking preventive action if you can.

Now we come to the important part of this discourse, how to prevent stroke. What can we do or rather should we do when these signs appear one by one. I am  not a doctor and I do not pretend to be one. What I am about to tell you is mostly from my own experience.

Firstly, when you find that your body is not functioning as it should, that some parts are slacking and not obeying your brain as it normally does, you should  start exercising.  Go for long walks.  Incidentally, you will experience immediate benefits even while exercising, such as clearer vision and mental alertness.  Make it a habit to go for walks at least three times a week. Do not stop. I did go for walks but then I stopped when the symptoms disappeared. I made the mistake of not exercising for far too long and then it was too late. The stroke struck!

Remember, regular exercise is very important in promoting blood circulation. Of course, other forms of exercises will be just as good for you. One word of advice, exercises performed with the use of machines are not necessarily the best and that is why I advocate free hand exercises like walking, jogging and swimming.

With daily exercise or without, one must daily do deep breathing exercises in some unpolluted or at least less polluted area (like near a sunlit tree) to take in full doses of oxygen in order to kick-start our amazing body machine

Drinking lots of water helps immensely. Drink at least one glass of water first thing in the morning.  Then drink one or two mouthfuls every half hour or whenever thirsty. This is to provide the blood stream with a regular supply of fresh water as our body gets rid of water all the time.  We lose water when we breathe, sweat and urinate. Lack of water means poor blood circulation which can lead to stroke.

Eating proper foods is also important and I mean greens and fruits on a daily basis. Everything else can be enjoyed in moderation. A monk who practices healing advised me on certain foods to take to prevent the occurrence of stroke. He said to prevent stroke I should drink a soup made of one cucumber and one red tomato.  Boil them together, strain and drink one or two glasses daily. That will help prevent the blood from coagulating (or is it congealing?).

Stroke affects the brain and the best remedy for it is egg yolk. The monk suggested I take the yolk from  free-range chickens leaving out the white. The egg must be hard boiled. Consuming egg yolks is also recommended for elderly people as well as school children because it helps to nourish the brain and thus improves memory.

What can we do when someone is suddenly seized by a stroke?

Chinese physicians use a pin to prick the ends of the fingers and toes, all twenty of them, and squeeze out a few drops of blood from each prick. The logic is that by drawing blood one stimulates the flow of blood, like unlocking a traffic jam. The needle must first be disinfected by putting it over a flame and wiped clean with tissue paper. Everyone and anyone can do this because there is absolutely no danger whatsoever. Wait, not everybody can do that. Oh?  Yes, those people who are afraid of blood, else we will have two patients instead of one!

Editor’s Note: This is an email and there are many strange and sometimes helpful pieces of information that we get this way. The effort here is to provide as much information as possible and then help you to decide.

Posted by: dlip | November 10, 2013

More company?

Going back to the archives, I came across this piece written fairly soon after my stroke. In those days perhaps I was in a darker mood and mindset. What do your think about this, consider it was 2008 and I had my stroke in 2007.

I have already mentioned the names and characteristics of two companions who insist on accompanying one on this road to recovery. To recount:

The first was “Depression”, that often times developed into ravines that were deeper and more stark than those in the Grand Canyon; this even though I believe the Americans have a tendency to exaggerate the size and quality of their possessions.

Which reminds me of the story about the yank and Banta Singh. Old Banta went to the airport to receive an American who, he was told, was a VIP as far as his company was concerned. By the time they were one hour out of the airport Banta Singh was fed up with the American bragging about the size and height of the sky scrapers in “Noo yourk”. When they eventually came by the Qutub Minar the American was completely awestruck by its height. “Gawd almighty” exclaimed the yank, what on earth is that?

Banta replied laconically; “don’t know it wasn’t there yesterday!”

Anyway getting back to the main theme of my narrative, I may mention that I have two pieces of news for you. One is good news. The other is bad news. The good news is that one has more co-travellers for company. The bad news is their names, one is christened, “Frustration” and the other is “Anger”. They are both very closely related to each other, one could say they were almost twins cloned from the same parents, “Impatience”.

Frustration arises normally from the individual’s inability to communicate clearly or properly which often times results in the other person having to respond with either a “begging your pardon?” , an eh? Or what? Depending on the family’s background and schooling that the other has received. All in all this results in one having to repeat oneself many times which becomes very tiring thereby preparing the ground for Frustration to enter the picture, and, depending on the alacrity or lack thereof of the response, Anger often lurks behind waiting to pounce from Frustration’s shadow and display his burning colours. It is with an effort that I hold Frustration down, because if he is controlled, Anger cannot break past him.

Another reason is that because of one’s numerous inabilities one is forced to ask for help/assistance from others for innumerable favours such as escorting one to the bathroom or to the dining room as also for putting on/off the lights, the fan or TV. Nearly every activity needs assistance which is not always forthcoming. One calls and the other does not answer – another cause for Frustration.

Note from admin:

I am happy to report that since those days of total dependence Dalip has come a long way. He is now able to -albeit with some difficulty and sometimes assistance – raise himself up from a chair and propel himself towards the bathroom so he can manage a few basic activities. However, the effort of rising from either the seated or a supine position is so monumental that for little things like turning off a fan or a light, asking for water or other small assistance it is still easier to call or ring a bell and wait for assistance. So another companion though a fickle one is Patience.

Posted by: dlip | July 30, 2013

How Common Are Seizures After a Stroke?

By now I have known a number of people who have suffered from a stroke, some mild and others much worse. All seem to have an increased tendency towards seizures.

One friend had several repeated seizures because the doctors couldn’t find the right balance of medications. Researching the subject on the internet revealed that a study reported that approximately 10% of all ischemic stroke survivors suffer at least one seizure by the 5th year after their stroke. The risk for hemorrhagic strokes was higher, as approximately 27% of patients with intracerebral hemorrhage and 34% of patients with subarachnoid hemorrhage, suffered at least one seizure during the same time period.

How Common is Epilepsy After a Stroke? The incidence of new onset epilepsy after a stroke is much lower than the incidence of seizures. Epilepsy after stroke is reported to occur in only 2 to 4% of stroke survivors. Yet, as whole, stroke is the most commonly identified cause of epilepsy in adults older than 35 and accounts for more than 50% of all new cases of epilepsy of known cause in the elderly population.

What Medications Are There to Treat Stroke-Related Epilepsy? Luckily, stroke-related epilepsy can typically be controlled with antiseizure medicines. But it is important for a caregiver to note and report minor episodes to the doctor.

The oldest and most commonly used medicines for this purpose are phenytoin (dilantin) and carbamazepine (tegretol) (Lamictal), but of course as always your doctor knows best what medicines to prescribe and how these will interact with other prescription medications that the stroke patient has to take.

(Ref. About.com: http://stroke.about.com/od/unwantedeffectsofstroke/a/seizures.htm)

Posted by: dlip | December 30, 2012

2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,600 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 4 years to get that many views.

Click here to see the complete report.

Posted by: dlip | October 12, 2011

The ripple effects of “isolation”

Before writing on the subject at hand it is necessary for me to explain what I mean by the term: “ripple effect”. When one throws a stone or any object into a pool of still water it causes a number of ripples that spread outwards from the centre. I do not remember, very clearly, the physics involved in the phenomenon, it being many years since I last studied the subject. In common parlance, a “ripple effect” refers to a cascading and infectious effect, where one phenomenon has a tendency to spread; the direction of the spread being outward. It has been in my case something like this:-
To begin with “isolation” begins with me (the victim) on account of my various inabilities; details of which, have been mentioned earlier on in this account.
I cannot see well so, I can’t read, I have stopped reading, then I stop watching movies, my TV watching reduces to the extent of almost nil. As a result of these numerous refrains, some avoidable, some not so avoidable, I deny myself facts, figures and information that keep me contemporary.
When I happen to be sitting in a group of people (whatever their age). The general tendency is to discuss books, movies, actors/actresses and current affair happenings, whether contentious or not. As a result of this ignorance I found myself to be in isolation whether in a group or by myself. Yes, the ripple effect of isolation was near completion.

(Note: There are other posts in this blog where the author shares his occasional feelings of despair. These emotions are to be expected in a Stroke victim)

Posted by: dlip | October 12, 2011

Doctor in a FIX!

By Jacqueline Colaco

It all started with Doc’s idea that he would FIX ME – and for sure, he did!

The story goes like this. We were childhood acquaintances living in Fraser Town, Bangalore, each the youngest of several children and were contemporaries in age, as were our siblings. He studied in a boys’ school and I in a girls.  We would meet at the occasional birthday party, picnic or family get-together.  Then we went our separate ways – he into medical college and I into banking.

Later he left for the USA and our paths did not cross for a long time.  Till one evening, about twenty years ago, while he was holidaying in Bangalore, we met up again at a common friend’s wedding.  He asked me for a dance.  I declined.  He was taken aback, and seemed to wonder at my high and mighty attitude. I could see him mentally deciding to FIX ME. He did not realise how true his intentions would turn out, but not in the manner he might have thought!

I could not dance because I had severe rheumatoid arthritis.  He did not know this until I told him so a little later, as he saw me struggling to get up and serve myself dinner. And then immediately, his orthopaedic surgeon’s concern came to the fore and we discussed my problem.  The next day, x-rays in hand, I went to consult him.  He told me I would need a total hip replacement in due course.  He was building a hospital in Bangalore and hoped to have it operational in a year. Joint replacement surgeries would be one of his specialties and he would perform my surgery here.  In the meantime he would visit Bangalore every quarter to supervise the local project and I could have a periodic check-up too.

After 18 months, my problem became acute and surgery was necessary.  As the local project was delayed, Doc asked if I could come to the US.  I gaped at such an impossible suggestion.  He offered to keep the expenses as low as possible and invited me to be his house guest during recuperation. My employer Bank of Baroda stepped in to help me meet the medical expenses and my sister Isobel accompanied me.  Soon I was in Oklahoma and fitted with a new ‘silver hip’, as my brother-in-law Alan would teasingly refer to it. We also made headlines in the local newspaper – ‘INDIAN BANKER SEEKS HIP REPLACEMENT IN CLAREMORE! What smooth sailing at the skilled hands of my generous friend!  My new found mobility took me places.  I could dance again!  Alas, three years later, one knee needed to be replaced.  Again it was time to FIX ME.

This time at the newly opened hospital HOSMAT in Bangalore, I was the first patient to undergo a total knee replacement surgery. All went well, and four years later it was the other knee that needed to be replaced, and back was I at HOSMAT. By now a veteran, seventeen years down the line in November 2008, it was my other hip that needed to be replaced. Once again, I’m moving successfully and painlessly on the quartet of my replaced leg joints, thus enabling me to dance my way through the walks of life again, because Doc FIXED ME! The added bonus was when I did indeed dance with Doc on his 60th birthday in October 2009.

Thanks, my dear friend Dr.Thomas Chandy and your caring HOSMAT team.

Posted by: dlip | October 7, 2011

Ministering Angel

 by Jacqueline Colaco

If ever there was one, this is she – Mini Jacob!  With her gentle persuasion and her winning smile, Mini is able to coax the most reluctant muscle or joint (read: stubborn patient!) into greater mobility.

Sensitive, but strict!  No lame excuses hold water with her.  The ‘I can’t’ syndrome does not work either.  Her ready repartee smashes all verbal attempts to escape.

Like when I say, “I am too old now – leave me alone” she retorts, “But life only begins after 40!”  She works on every stiff and aching joint of mine (rheumatoid arthritis).  Be it fingers or toes, her skilful manipulations make them dance.  A few tweaks (from her) and shrieks (from me) won’t harm, says she.  Be it knees or hips, the quads and hamstrings must perform.

“How else will you walk properly?” she asks me.

“But I’m disabled” I tell her, “I don’t need to walk like Miss World!”

“No,” she comes down heavily on me, “you are not disabled and yes, you can, so practice getting rid of that limp.”

And she shows me how I should walk.  And then she takes me walking up the stairs.

“Hips forward, back erect. Look up.”

And once I’m up, it’s time to walk down.  She stands on the landing below – patient as ever, while I dither in making a descent.

“No, don’t look at me.”

“But you’re so pretty,” I demur, trying to delay that first plunging step.

She pretends not to hear.

“Look forward, bend your knee and just step down,” – (sternly now) – “you can do it.”  As if it is the easiest thing in the world.  And then – a spark of ego inside me dictates that I should accept her challenge.  My eyes sparkle with defiance and I try to do my best.  She has me hooked.  It’s not so difficult after all, I find.  And she nods in approval.  I feel so great that at last she’s satisfied with my performance. The result of our hard work together, day in and day out. I know from the look on her face that it hurts her as much to hurt me, but she does it for my good.

When people tell me: “you are walking so well now,” I say a silent prayer of thanks to this ministering angel – my physiotherapist, my psychotherapist, my friend.

 (Jacqueline Colaco is the Founder/Adviser of Arthritis Foundation (India). A former Bank Executive and India Hockey Player, Jacqueline was struck with RA at age 37 and for the past 15 years has been reaching out to arthritis sufferers and people with disability.  Check  – www.arthritisfoundation.in)

Posted by: dlip | August 17, 2011

Massage & Exercise for the face

Who’d have thought that what works for a luxurious facial also works for the muscles on a stroke victim’s face!  However, when you think about it, it seems obvious. And it wasn’t until I actually saw the way the muscles on the face are laid out, that I made the connection.

Study the attached diagram, and you’ll see that it’s almost as if Nature had laid out the blueprint for the flow direction of the massage.

To get started, first sit comfortably at the patient’s head with the top of the head resting on a towel facing your chest and the body away from you. If that sort of a massage bed is not available then sit on the bed and pillow the patient’s head in your lap, placing an absorbent towel on your lap. Make sure you’re comfortable and your back rests against a headboard. Keep a jar or bottle of the stroke patient’s favourite moisturiser handy. Dab a little of the moisturiser on your fingers each time you start to massage a certain area of the face.

Starting at the cleft of the chin massage upwards in a soft firm motion towards the eyes. Next massage around the mouth and upper lip, for this it is better to just use your middle finger. Follow a figure of eight or infinity-sign motion when massaging around the eyes. To massage the nose, use the middle fingers of both hands and gently pull the skin up towards the bridge of the nose and up between the eyes  – see the red musculature in the diagram. End the massage around the nose with a downward stroke towards the cheekbone. Lastly massage the forehead, again following the blue and black muscle structure. But as a final stroke massage the forehead laterally meaning towards the temples. Make a few circular massaging strokes on the temple area. And, before you end the facial massage put a small quantity of the moisturiser and massage the neck starting at the base of the neck and massaging upwards; scoop you hands in behind the neck to give the back of the neck a massage too. You may find doing this  easier than turning the patient around completely.

Once you have massaged the face the muscles will or should be relaxed and loose. Now get the patient to do as many of the following Facial Stretching Exercises – adapted from the Strokehelp blog. Each stretch should be done 3 times working up to at least 5 repetitions.

Facial stretches:

  • Raise eyebrows as high as possible, then relax.
  • Frown as hard as possible, wrinkle nose, and bring eyebrows together.
  • Open his/her mouth wide and stretch it as much as possible.
  • Smile widely while keeping the lips closed.
  • Puff out your cheeks and stretch them as much as possible.
  • Pucker lips as if giving a kiss.
  • Make exaggerated vowel sounds (A, E, I, O, U) stretching as much as possible.
  • Sticking the tongue out as far as possible.  Then, move tongue to the right, to the left, up towards the nose, and down towards the chin.

Jaw stretches:

  • Move the jaw to the right side as far as possible until it pulls but does not hurt, Hold 5 seconds.
  • Move jaw to the left side as far as possible, hold 5 seconds.
  • Alternate right to left jaw movement 5 times.
  • Move the jaw around in a circle making it move as far in each direction until a stretch is felt, but no pain.  Repeat 5 times.

Lip Exercises

  • Lip Retraction : Spread lips into a smile . Hold for 5 seconds. Relax and Repeat 5 times.
  • Lip Protrusion: Pucker lips as if about to kiss someone and hold for 5 seconds. Relax and repeat 5 times.
  • Lip Retraction and Protrusion: Alternately smile and then pucker your lips. Relax and repeat 5 times.
  • Lip Press: Open mouth as wide as possible and hold for 5 seconds.  Then close mouth, Press lips tightly together for 5 seconds. Relax and Repeat 5 times.
  • Pucker lips and make a kissing sound.  Practice slowly 10 times.
  •   Suck  lips into the mouth, then release in a loud smacking noise.  Practice slowly 10 times.
  • Keeping teeth together, say these sounds: “ba, bi, bu,” exaggerating the lip movements. Practice slowly 10 times.

Tongue Exercises

  • With the mouth open protrude the tongue. Be sure it is straight out, not resting on  lips or pointing to one side.  Maintain this position for two seconds.  Practice slowly 10 times.
  • Protrude the tongue and move it slowly from corner to corner over your lips.
  •  Protrude tongue and point it upward toward nose; hold for two seconds,  then relax.  Practice slowly 10 times.
  •  Protrude tongue and point downward toward the chin; hold for two seconds, then relax. Practice 10 times.
  • Move tongue around the lips in a circle, touching all of upper lip, corners and lower lip; relax.  Practice slowly 10 times.
  • Raise the tip of the tongue and touch the upper lip, the upper teeth and the ridge behind the teeth and the hard palate.  Practice slowly 10 times.

Inhale and Exhale Exercises

  •  Puff out the cheeks and press the fingers against one cheek without allowing the air to escape through the mouth or nose.  Practice slowly 10 times.
  • Blow on straw keeping a finger on one end and maintain the air in the straw for 5 to 10 seconds.  Practice 5 times.
  •  Say the (s) sound “ssss” without allowing the air to come through the nose.  Practice slowly 10 times.
  •  Repeat “ka” 20 times, “ga” 20 times, and “sss” 20 times.

Note: I have removed some of the prescribed exercises as I think those are better handled by a professional speech and/ or physiotherapist. For a more detailed list of exercises visit: http://strokehelp.wordpress.com/speech-exercises-2/

Posted by: dlip | June 2, 2011

A bit of gallows humour

Sometimes the stroke sufferer feels like a trophy. A memento to a time that was. Kept there in a corner on a pedestal with four wheels, two large, two small; or left sitting like Patience on a pillar with four legs and a cushion at the back lest the once valuable article should fall down and break. Dusted off periodically and if the curator of the museum remembers, the cobwebs are removed. It’s not that I’m not grateful, it’s just that some days I wonder what would happen if the statue smiled, stepped off the pillar stuck its tongue out, waggled its ears and walked away. Would the onlookers applaud?

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