Submissions from Readers

Denial After Stroke

by Jan
(England)

Question: My husband has paralysis on the left of his body. He denies this and keeps thinking he can come home as he is ok. Every day I have to tell him he has had a serious stroke bit it does not register. I am finding this very hard. Is there anything I can do? I pick up his paralyzed hand and ask him to move it which he can't do. He is having physio and surely would realize he can't move his leg and hand. I have heard about this denial but don't know how to deal with it.

Answer: Denial can be a problem, but it sounds more like your husband may have left side neglect. Left side neglect can be severe with the patient totally unaware of his or her affected side and the deficits present. There also can be cognitive changes that make it difficult for the stroke patient to understand what has happened. If this is the case, all you can really do is gently remind your husband of his deficits and try to increase his awareness of the left side. You can view information about neglect at www.stroke-rehab.com/unilateral-neglect.html.

If your husband does not have left side neglect or cognitive deficits then it may be denial. Denial at first is common but should resolve with time. The emotions one experiences after stroke are similar to the grieving process. A variety of emotions will occur. Denial at first helps protect a person from being overwhelmed by the changes in their life. Other emotions that may emerge are anger, guilt for being a burden to others, depression, and anxiety to name a few.

You as a caregiver will need help and support through this journey. I recommend that you visit the caregiver and resource sections of this website which will help you find support forums online as well as give you information on how to cope as a caregiver of a stroke patient. Their is a wealth of information from other families who have been in the same position as you, and I highly recommend all caregivers to use the internet to find these valuable resources. Specifically the links on this website that may be helpful for you:

www.stroke-rehab.com/caregivers.html

www.stroke-rehab.com/stroke-support-groups.com

www.stroke-rehab.com/caregiver-assistance.html

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What to do if patient refuses to be evaluated by a physician?

by Laura
(Doniphan, MO, USA)

Mistrust of Medical Providers

Question: My Mother had a stroke about a month ago. She is highly paranoid. She doesn't trust doctors or anybody else for that matter. We can't get her evaluated to determine the cause....it makes me highly concerned about her having another one. She sees a chiropractor who refuses to adjust her neck now because of all the obvious side effects from what appears to have been a right-brain stroke, but he did write down three things he wanted her to take: fish oil/2000mg, COQ10/400mg, and an aspirin.

She won't quit driving and there has been quite a few close calls due to her cognitive impairment. I know this because I keep finding a way to go with her. I can't keep this pace up though. I have a little boy who was diagnosed with Cystic Fibrosis and has to have alot of care. She used to be my back up person, but now I don't have anyone. Its been really hard on me not having her connect with me the same way and not having her support, but rather becoming hers.

I did call 911, but they said they cannot make her do anything if she is coherent enough to refuse. She suffers from a personality change, shes no longer outgoing, but rather withdrawn. She generally doesn't talk unless you speak to her first. Her speech has wrong context and misused wording and she is too impulsive when driving. She has this strong urge to pass everyone, even if their going the speed limit, and she won't consistantly use turn signals. She's dangerous. Nobody can talk to each other away from her because we're all suppose to be plotting against her when we do.

She's also eating too many sweets now. She used to be deciplined with it, now...she won't eat without dessert.

I don't know if theres any advice you can give me, but it helps to talk since I don't even have a support group to confide in. Thanks for your time.

Answer: If you haven't already, you should express your concerns to your mother especially regarding driving. You might be able to use driving as a reason to get her to visit the doctor telling her that you don't feel comfortable letting her drive until she has been examined and cleared to do so. A stroke can affect your vision, reaction time, and cognitive abilities so it is important to be cleared by a physician prior to driving. You may not be able to get your mother to listen regarding other issues, but unsafe driving is not okay. This endangers the lives of others. You can explain to her that if deficits are found that she can participate in driving rehab to help correct deficits (thus getting some therapy or stroke rehab she may need).

If she won't listen, then I would contact the motor vehicle department in your state and see what the procedure is for reporting an unsafe driver. I know in some states that as a relative you can report an unsafe drive without your name being revealed to the person. The motor vehicle department can then look into the situation further and may even require release from a doctor before the person can drive. Information for reporting unsafe drivers in Missouri can be found at: http://dor.mo.gov/faq/drivers/unsafe.php#1

The best way to handle parents who have declining mental or physical abilities is with honesty and respect. However, if your mother has cognitive deficits, she may not be able to reasonably respond to your concerns. I highly recommend that you find an online caregiver support group to share your frustrations and find helpful answers.

Visit www.stroke-rehab.com/caregiver-assistance.html for a list of websites dedicated to helping caregivers.

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Dear Old Dad Needs Help

by Tim
(Michigan)

Question: My dear old Dad needs help. He just turned 83 and has dementia. Last year he had surgery to correct a ruptured colon. During his ordeal he suffered a stroke and a heart attack.

I am happy to report that he has almost fully recovered and is leading a normal life. Except he now needs assisted living but doesn't recognize this fact. He really thinks he can live by himself and set a goal to do that.

He has been given a daily regimen of medication which he only takes if they are handed to him. The problem is he assumes this is a task being forced on him.

Do you have any advice on how to train a stroke victim to take their medications voluntarily instead of having to give them to him? If Dad could do this by himself it would go a long way to gaining his independence again.

Tim

Answer:
The elderly often feel they are losing control of their own lives especially when faced with illness and/or dementia. Some general advice for caregivers of family members with dementia is never let the person with dementia be in a situation that endangers his or her well-being, but do allow the person as much control over the situation as he or she is able. It is no fun to go from complete independence to having your children tell you how to live.

I'm not sure of the severity of your father's dementia based on your question nor whether your father still has his own home, lives with a relative, or is in a facility. Since you only asked about taking medication, I will address that issue, but there are many aspects to consider when dealing with the elderly parent who wants to live independently yet may not be safe.

It is best to be upfront and honest with your dad and talk to him if he is capable of discussing the matter. Many times, you will not know what a person with dementia is capable of doing until you give them a chance (within the boundaries of keeping them safe of course). Maybe if your dad is given more control to take his medication, he will be more willing to cooperate.

You can talk to your father and let him know that taking regularly scheduled medication is necessary if he wants to obtain independent living. If your dad is able to understand, involve his physician in explaining why each medication is necessary. You can then consider different options to help him take medications.

There are various medication dispensers that will help remind a person when to take medicine. If you are concerned about over or underdosing, one option is an automated medication dispenser that you prefill and has a lock. The dispenser will allow only the right amount of medicine to be taken at a certain time and will not allow the person to take too much medication. These dispensers also come with alert tones that let a person know when it is time to take medication.

Another option is simply human monitoring via frequent visits and telephone. Again, I don't know the severity of your father's dementia or where he is currently living, but some dementia patients may just need encouragement and reminders (not demands) from their loved ones.

If your father just flat out refuses to take medication on his own then you have a tougher problem. If cognition is too limited or your father is unyielding, then he may not be able to manage medication on his own.

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