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What the psychiatrist ordered....


1967stingray

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Finally after weeks of waiting, the big day arrived. I was so anxious that we ended up getting there early, despite getting a little lost. Very unusual for me. Luckily they took us in early too, Ray hates waiting in doctors waiting rooms so I was grateful for that.

 

The doctor was a sweetheart and not only took his time but was very sympathetic about everything. Asked questions about things I had never considered, but should have; Ray has never peed in a potted plant by mistake so I guess he's a lot better than I thought! He kept writing a list of tests and things he wanted me to do before our next visit mid-February, there was no way I could have remembered it all in my head. Some of them involve staying at a test site for a few days; it will be hard to convince Ray to do that, he is more and more afraid to let me out of his sight recently. Unfortunately I had a sore throat and a cough, unaware that I was coming down with the flu, so I have been out of commission for a few days and will have to start making the calls Monday.

 

First off, he told me I had to read a book called "36 Hour Day" which is about dementia. He made a point to tell me that there are similarities between stroke and dementia and he didn't mean Ray necessarily had it, just that it would help me as a caregiver. I was able to order it from my library, they are well stocked on it so it must be a good one.

 

Then very next thing, he wants an MRI to check for dementia and microinfarcts. OK, guess it can't hurt. Bloodwork but we are already going later this month for our primary and a lot of the same tests. The test I really hate is when doctors test Ray by shooting him questions and he gets half of the answers wrong, he seems all there to me when we talk but maybe it's my imagination. But it does upset me when doctors act like Ray is worse than I think, while I'm telling myself how well he's coming along. I could be living in a dreamworld. The neurologist does the same thing and it always leaves me in a funny mood for the rest of the day. Anyway he didn't change any of his meds, just switched them around and changed the doses for now. But he is asking one of the tests to consider Depakote instead of Dilantin, he says he doesn't like Dilantin.

 

Then the overnight tests. Ray will never go for these, although I will try. It would be nice to have a day or two off from caregiving, but he will want me to stay with him if it ever happened. First a 24 to 72 hour video EEG, doc claims it is like being in a hotel room, wonder if there's a TV. I doubt it, I don't think you are supposed to have outside stimulation? I can't remember the short one he had, but the technician did blab to me the whole time so maybe not. Ray really isn't competant enough to know it's for his own good and this will not be pleasant news to him. More like going to jail, not a vacation. The other is some kind of sleep study for apnea, which sounds like another overnight. He had bad apnea when he first came home, but it doesn't seem that bad now, wonder if it's really necessary. For a cure, all they do is give you a mask with oxygen from what my neighbors tell me, and none of them could stand it for more than a week. They said they felt like they were suffocating, and a waste of money.

 

As for me, I already have an appt with their social worker (despite having an in home one monthly; but she is useless, I know more than her, so why not) and then I have to make an appt with another doctor there for a caregiver psych visit. Guess that will be on my insurance, although I hope not!

 

Next he gave me an eval to get Ray back to PT; his speech therapist (whom he adored) contacted me yesterday about coming back since it's a new year, so far Ray is NONONO. I hope to change Ray's mind somehow, just to get him out of the house even once a week for the next couple of months. Just for the socialization if anything. Doc also wants a dental eval, but unless Medicare covers that, I don't think I could afford what I know he needs. I was just sitting there being a little overwhelmed by all this. Everything's been the same ol', same ol', for so long now, it will be hard to get out of our rut.

 

One thing that really encouraged me was that I mentioned the support I get here, and he asked and wrote down the website like he was going to check it out. He really did seem like this was more than a job for him, that he enjoyed figuring out how each patients brain works. So I am going to set up as much as I can in the next month and a half, and maybe we can get this show on the road again!

 

Afterwards we met our friends at a nearby authentic Chinese place and had a New Years Eve feast of unbelievably delicious and exotic dishes, Ray ate some of everything which was surprising and wonderful to me. Then I went home and realized something was wrong, turns out I was coming down with the flu. Struggled through New Years Day, managed to make the turkey dinner I had planned, was in bed the rest of the day. Couldn't sleep all night as I developed bronchitis as I always do. Spent all day Wednesday on the phone with my doctor, ordered chest xray and start on penicillin. Pat our aide/guardian angel, happened to call in case we needed her because she had a cancellation. Did we ever! She ran over with some (more!) Chinese food because she knew I couldn't cook, watched Ray while I got the xray, then insisted on picking up my prescription. While she was gone, the doctor called and said he just saw that I said my temp was spiking at 104 and wanted me in immediately. Pat returned with my pills and although it was past her working hours, again insisted on taking us in her car so she could watch Ray. The doctor let me go home, I took the first dose and went right to sleep. Ray was pretty good and stayed downstairs by himself, but I know he was scared. I checked on him once or twice, and by the time I went down to get him to bed I felt 90% better. I can tell the symptoms will linger, but yesterday I made a pot of turkey soup and did all the laundry so I'm doing OK. It's been a crazy start to our New Year so far!

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Don't know about your area where you live but here people are coming down with the Flu bug almost daily and as reported on TV and all of these people had proof of getting their Flu shots! So I hope that turkey soup made you better in feelings at least so maybe it won't last too long!!

 

Supposedly the Flu season has started early for unknown reasons!!

No one want to be down sick especially with the Flu and a care giver too!!

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Thanks Fred, feels good to know I'm not the only one, and that not getting the shot wasn't a big deal. The nurse at my doctor's office yesterday told me she didn't get it either. Ray isn't being really compassionate about it, but then I go upstairs and take a nap and he's glad to see me again in awhile.

 

The soup is helping and also the Szechuan Chinese food leftovers we got New Years Eve. If I make it through, I'll know I'm pretty healthy overall I guess.

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Sting: I am glad you are feeling better. I am just getting past the height of it I hope. Started Tuesday night. I did get the shot and while the body aches are pretty bad, the respiratory part of it is better. And I smoke. But yes, sleeping and fluids are what works best. Bruce makes me tea - LOL. A co-worker has been checking in on us, which is very nice - running errands, bringing in food.

 

Anyway sounds like you and Ray are in for a marathon. Get the tests done that Ray is comfortable with, then you can consider the overnight EEG and Sleep Apnea test. But please do read up on the sleep apnea and the BiPap or CPap that they use for it. Col, this is not just oxygen by a mask. It is a pressurized oxygen delivery system that forces the lungs to expand and contract. Just delivering oxygen to the lungs does not help if the lung system does not absorb and deliver the oxygen to the body and that is the "apnea" part. Yes, it is a bear to wear the mask and get used to it. There are some here who have experience with it and hopefully will chime in.

 

In the meantime, please keep a good journal and please share so we can follow along with you. This is one of the most in-depth studies I personally have heard about and it will be very interesting to share with you.

 

I often wonder too when Docs who should know better start with the rapid questioning. They must realize that stroke victims sometimes need time to process. It is not that they don't know, just have trouble forming the words and getting them out. Bruce has to do his Psych-Neuro again this spring and I am dreading it. Last time I had his Speech Therapist re-give it and if I am unhappy this time, I will call her. But I have a good feeling that you won't have any of those difficulties with this Specialist.

 

Your work is definitely cut out for you through the rest of the winter and spring. Do push for the therapy. Bruce's Physiatrist is next month for the Botox and with the new year, I am hoping she too orders up some therapy. Good weekend. Debbie

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Lauren was diagnosed with dementia when he had an eval by a neuropsychiatrist. He wasn't able to do most of the testing so it was only minimally helpful but that word is in the conclusions. It didn't really tell me anything I didn't already know. I have downloaded the book to my Kindle. It might provide some helpful information.

 

Lauren also has severe sleep apnea. His is called complex central sleep apnea and is life-threatening because of the long pauses he has in his breathing. I think he had sleep apnea for quite some time prior to his stroke but it became much worse after. The sleep specialist we see for this condition came to a stroke support group we attend and he opened my eyes to how serious this condition can be. Sleep apnea is thought to be a cause of both heart attacks and strokes. Lauren had a heart attack 2 years before his stroke and the stroke was caused by a clot that formed in his heart. I just wonder if this condition contributed to the original heart attack. Lauren has a BiPap which provides a higher level of pressure that kicks in when he stops breathing and forces a breath. The doctor said it's almost like a ventilator but outside the body. We started with a mask that covered his nose and mouth. He kept pulling that thing off in the night causing me no sleep most of the night. We moved to a nasal piece that just goes inside his nostrils and is a soft pillow. He has tolerated that much better. The machines have become much quieter than they used to be. The nasal piece still gets dislodged sometimes and causes noise until it is repositioned. To me, it is a must that he wear it. He definitely sleeps better with it and the sleep is more restful. But, most importantly, he breathes. I have heard of many people who sleep so much better with it that they are happy to adjust to the initial discomfort because they feel so much better in the daytime. A good number never adjust. Still, I think if they are recommending it, it would be a good idea to go through the testing. That way you'd know what you are dealing with.

 

We had the sleep apnea test done in a hospital setting but it was in a unit separate from the main hospital. The bed was very much like a hotel bed and the room did have a TV. They set the test up for when you sleep, though, so once the actual testing was started the TV was off for bedtime. I could have stayed with him but chose not to do that. He was fine without me and I needed my sleep, which I was certain would not happen there.

 

I will be interested in hearing about the ongoing process too. Sounds quite involved.

 

Hope you are on the mend. That flu bug seems to be a bad one this year. ~~Donna

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Hi Colleen. It sounds like you have found a good specialist. He seems to be thorough in checking everything out and not just a "pill pusher". I have not taken Larry to a pyschiatrist. He has seen just about every other kind of doctor and therapist though. His internist usually keeps on top of what specialist Larry needs to see. Right now he sees 4 doctors and two dentists on a regular basis. We have 3 of those coming up in the next 2 months.

 

As for the sleep apnea, Larry has been through it all. Two sleep over tests, two different sleep masks, numerous calls and visits from the sleep therapists and nuero, and he still could not adjust to wearing the thing. He has severe sleep apnea, but I don't think these experts know how hard it is for a stroke survivor to adjust to this. It is bad enough to only have the use of one hand/arm, plus have to get up to pee 2-3 times a night! Hopefully you will have better luck. I know it can be lifesaving.

 

Julie

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Thanks Julie, for your side of the story. So many people have told me how they couldn't stay with the mask, and with Ray being "the princess and the pea" that he is, he will be sure to resist. I'll just put it on the bottom of the list but will get it done, due to Debbie's input.

 

Just picked up The 36 Hour Day and I am blown away. Every page I flip to has the most pertinent information on every subject a caregiver faces, it is amazing. I have a lot of reading ahead!

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