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When “Brain Drain” is a Good Thing
June 21, 2011
Dad’s back! He had become an incontinent, doddering old man who was quickly forgetting things. He was in danger of being shuffled off to a nursing home.
Fortunately, he fell.
I say “fortunately,” because he was taken to a hospital by the EMTs who came to pick him up off the floor. They feared he may have hit his head.
As it turned out, he had a urinary tract infection (UTI), bladder stones, a 90% blockage in his carotid artery, and normal pressure hydrocephalus (NPH).
Now, some things I’m a bit unsure about. Because he lives in South Carolina and I live in Indiana, and because I can’t yet travel by myself (can’t get the scooter in and out of the car or van), I couldn’t go to see him. While I prefer seeing for myself, my youngest brother and his wife kept me informed. I also had a code I could use that allowed Dad’s nurse to talk to me about his condition.
They found the UTI fairly quickly. As someone who has had a few of those, I can attest that you really have to pee. A lot. Can’t get more than about 10 feet from a bathroom. So, there’s part of the reason for the incontinence.
I didn’t even know there was such a thing as bladder stones and originally believed they were kidney stones that got to the bladder and stayed there. Nope. They’re a different animal, and he apparently has quite a few of the stones. He’ll have to have them out when he regains some more of his strength because they can cause infections and long-term bladder dysfunction. By the way, gentlemen, you’re more susceptible to bladder stones than the ladies.
The blockage in the carotid artery? Now there’s a problem. The carotid carries blood to your brain and head and a blockage can prevent oxygen-rich blood from going to the brain, causing a stroke or a transient ischemic attack (TIA), also known as a ministroke. Dad’s doctors are trying medicine to handle the blockage in his carotid artery to see if that works before putting in a stent. They fear part of the blockage could break off and lead to the stroke they’re trying to prevent.
Now for the NPH. Basically, it’s too much water on the brain. By “water,” I mean cerebrospinal fluid (CSF), which cushions the brain and carries nutrients to and wastes away from it. Normally, excess CSF is carried away from the brain and absorbed in other tissues. However, not always. Docs put a tracer in Dad’s CSF and tracked how long it took for the excess fluid to drain. It took a bit too long, meaning that that he had too much fluid in the ventricles of his brain, causing pressure.
And too much pressure on the brain can lead to…wait for it…urinary (and sometimes fecal) incontinence, an unsteady gait and cognitive problems (i.e., symptoms of dementia).
So they drained the excess fluid from his brain. I’m not sure if they already have, or if they will, put a stent in to continue draining excess fluid from his brain. I do know that he’s getting better every day.
Kudos to the hospital for looking beyond Dad’s age to find the medical reasons for his symptoms.
He’s weak, but I was, too, after being in the hospital for five days. Dad was in for about two weeks. And, with his physical problems, he wasn’t in great shape before he was admitted. I had to occasionally use my transfer board for the first time in months for a few days after I got home, but I quickly got back to transferring without the board. It’ll take a while longer before Dad can get his strength back.
But this leads to a question that has to do with all of us. You know how things tend to get blamed on our diabetes, whether the diabetes has anything to do with it or not? My most egregious “oh, you have diabetes” moment was when I kept complaining of foot pain to a former podiatrist. “Oh, you’re a diabetic,” he’d say, waving off my concerns.
But it had nothing to do with diabetes: I had broken bones in my foot as the result of a fall down some steps. Because of the unwarranted delay in treatment, nerves were damaged and had to be removed. The doctor failed to look beyond my condition (diabetes) and find a medical reason for my foot pain.
It’s assumed by many that I had an amputation because I have diabetes. Nope. Sorry, Sherlock. It was a bone infection. I mean, people I don’t even know ask me if I have diabetes when they notice that my left leg ends a bit short of the floor. I’m not always sure they believe me when I tell them yes, I do have diabetes, but that’s not why I had the amputation.
Will we also be “misdiagnosed” if we get NPH when we’re elderly? It’s most common in the elderly, you know. Somewhere I read that 5% of people in nursing homes who have NPH were assumed to be exhibiting the symptoms because they were old. Because Dad is 87 years old, it was assumed by many that his problems were because of his age. Why bother to look any further if the patient is 87 years old. Right?
What are we supposed to do if we get stuck in a nursing home because we’re old and senile, not to mention relegated to sauce-free boneless, skinless chicken breasts for an entrée and sugar-free gelatin for dessert because we have diabetes? (Not that there’s anything wrong with boneless, skinless chicken breasts or sugar-free gelatin.) Kick and fight and yell for a test for NPH?
Right. Like anybody will listen to an incontinent, doddering, demented old fart. Maybe we’ll merely be sedated, just as Dad was when he got upset when a couple members of my family began to talk about putting him in a nursing home? In front of Dad, as though he weren’t there. Or couldn’t hear them.
At least when we “only” have diabetes, we have the “right” to ’splain; to complain. And if the person won’t listen to us, we can leave. Maybe. I’m already getting tense, thinking about my upcoming surgery on June 27 to (finally!) get that #$*& gi-normous stone out of my kidney! Oh, I’m not getting tense about the surgery: I’m getting tense about being treated like a know-nothing Type 2 “diabetic” (I abhor that word) instead of a human being with a brain.
On a hopeful note, however, when I met with the surgery scheduler and sighed that I never seem to get into a hospital where my endocrinologist has privileges, she wrote down his name. And when the nurse called with pre-op instructions, she had Doc’s name in front of her. She could even pronounce it. Turns out she knows him. So there’s hope.
And hope for Dad, too. I’m looking forward to (knock wood) seeing him late next month, along with my brother and sister-in-law. My husband and I rented a cabin in the Great Smokey Mountains that’s about halfway between our home in Indiana and theirs in South Carolina to kick back in for a few days. Dad should be much better by then. When I originally had mentioned meeting in the middle, as it were, it was feared Dad would be unable to make the trip.
But, as I said, he’s doing better cognitively and physical therapy should have him more mobile by then. I’m helping, too: I baked and sent him a batch of his favorite cookies. It should help with hand-to-mouth coordination.
And to think many of his problems were primarily due to a bit of excess fluid in the wrong place. Gives new meaning to the phrase “brain drain,” doesn’t it?
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