Addiction in Seniors Prescription drug overuse part two

Yesterday I touched on the fact that senior men are more likely to abuse alcohol and senior women more likely to abuse medication. I touched on some of the issues with alcohol and today my focus will be on prescription drug misuse. 

Prescription drug abuse is defined as the misuse or nonmedical use of a controlled pharmaceutical drug (i.e. needs a prescription) for something other than its intended purpose. For example the prescription belongs to someone else, or you take it to feel good or high, or you take the drug while drinking alcohol or you take a higher dose of the drug or take it when you do not need to take the drug.

Abuse of prescription drugs can produce serious health effects and lead to substance dependence. This can be extra dangerous among seniors partly because we are more likely to take multiple prescriptions, thus increasing the risk of negative interactions. For example those who take benzodiazepines (e.g. Xanax, Valium) more likely to fall or have a car accident.

To understand the possible extent of the problem you need to understand that 20% of Canadians over the age of 60 obtain long-term prescriptions for pain. 

Research into prescription drug use among  B.C. seniors showed that we are taking approximately 15.7 prescriptions each, according to the Canadian Centre for Substance Abuse. That is a lot of drugs.

In BC the government set up Pharmanet which links B.C. pharmacies to a central data system. This program was set up to prevent accidental duplication, fraud, drug interactions and dosage errors. 


In a recent year, over 47 million prescriptions were processed and the system flagged more than 24 million potential drug interactions. The role of Pharmanet in detecting possible interactions and dosing errors is important. However, the statistic about the number of potential interactions is really scary.

Available evidence suggests that Canadians are among the heaviest consumers of psychotropic medication in the world. However, there are few Canadian statistics on the number of people who use prescription drugs for non- medical purposes. There is minimal research information available regarding the extent of prescription drug  abuse in Canada. 

But we do know somethings we know that the most commonly abused drugs are:

• Opiates used for pain relief (e.g. such as codeine, morphine, Vicodin and oxycodone)
• CNS (central nervous system) depressants used for anxiety, panic disorders and sleep disorders (e.g. Nembutal, Valium and Xanax) These slow normal brain function and produce a drowsy, calming effect
• Stimulants and amphetamines for weight loss programs and sleep disorders (e.g. Dexedrine, Ritalin and Adderall). These increase alertness, attention and energy. They also increase blood pressure, heart rate and blood glucose

Many of the drugs we take can be addictive, it is important to check with your doctor to see if any of the drugs you are taking are addictive. If they are you may need to limit or change the drug. Always check with your doctor and take the prescriptions as they are meant to be taken.  

Quality of Life for your parents

When we were growing up, our parents were our care givers.  They made sure we were safe, well fed, clothed had medical care and that the money was there for the things we needed.  

But being a caregiver for your mom and dad is about more than just giving you the basics of survival and health.  Many of us as Boomers still have ageing parents to care for and this can be a strain as we move into retirement and we face the prospect of them moving in with us, or they face the prospect of moving into a retirement home.

Now our turn has come to be the care giver for our parents.  They need you now as they move into their older years and they are less able to attend to those basic needs of life.  But you have a responsibility to assure they are safe and that they have the right food to eat for their diet. 

You can make sure their clothes are clean and that their medications are there for them every day.  You also can look after their finances so there is plenty there to take care of the necessities of life and none is wasted or taken from them by scam artists.

But just as growing up in a family, there is another element of being a care giver and that element can be boiled down to the phrase, “quality of life.”  That is a good phrase because if in our childhood we had times of joy and happiness because we were part of a loving family that was because our mom and dad went beyond the physical basics and made your life fun, full of love and laughter and good times that you would remember forever.

Perhaps you can still remember those times with your parents today.  But as you remember those terrific vacations or all the wonderful, Christmases and the many funny things that happened in your family when you were growing up, your parents made sure your life was rich and full that way.  And those people or that person are these same person you are now charged to care for as they age.

So how can you do all you can to enhance the quality of life for your parents?  If you can find ways to give them happy times, time of laughter and love, that will be a fitting pay back for the loving household they provided to you all those years.  Here are just a few things you can make happen to make their lives happier…

•     Dinner every week.  If you have a routine time when you either come to your parents home and bring dinner or have them to your place to enjoy some family time that will become a favorite night of the week for your parents. 
•     Lots of family time.  The real value of being in the same town as your parents is they can have lots of time with your family.  So let them be part of many of the family things you do such as church, school activities and fun outings during the spring and summer as well.
•     Make the holidays festive.  What would the holidays be without Grandma?  And if Grandpa makes a good Santa Clause, you are all set.
•     Make their house a home.  As a caregiver, sometimes the chore of cleaning and maintaining your parent’s apartment falls to you.  
•    But don’t just “settle” for a nice clean look.  Dig out those great things that mom used to have on the walls and shelves at home when she had her own place.  Try to give that room at the senior retirement center as much like home as possible so she will feel comfortable and happy among the things that mean this is her place and hers alone.

If you can create the same joy, the same fun and the same sense of “home” for your parents that they were able to create for you and your siblings growing up, then you will have taken one more step toward giving back a little of what was given to you. 

But there is a real value to giving your parents the same love and good times they gave to you.  Laughter and love and happy times are therapeutic and can do a lot for the health and well being of your parents.  So put that extra creativity you have into really giving to your parents the quality of life they gave to you and they will blossom where they are planted, just you and your siblings have in life.

What to Do If You Learn You Have a Terminal Illness or Serious Injury

This is the time of life when we find ourselves facing these issues, either for ourselves or for a friend or loved one. There’s no easy solution if you have a serious or even life-threatening illness or injury. It’s not easy to cope with such a catastrophe, but you can make the best out of a difficult situation.

Sometimes, even a situation that appears to be hopeless turns out to have a silver lining. If you learn to deal with the situation in the most effective way, you will have the best chance of healing and having the highest quality of life possible.

First, you should immediately learn as much as you can about your illness. An informed patient feels more in control. Second, think about seeking some outside assistance for support. Some possibilities that have been proven to work are:

Getting counseling from a psychologist or counselor – People generally find that when they are able to talk about their fears and concerns, it eases their worry. The advantage of going to a professional over friends and family is that you can speak freely without any worries about making anyone else feel upset.

Joining a support group – People generally find that it makes them feel better to learn that they are not alone. Interestingly, statistics show that people in support groups live longer.

Getting involved in religion – While this option isn’t for everyone, there are many people who find great comfort in religion when confronting such difficult situations.

Even though you may feel isolated, don’t shut your friends and family out of your battle. If you learn to speak openly and easily about your problem, they will become comfortable talking to you. This will make things much easier for you.

Also, don’t be filled with foolish pride. Accept help from others. This can help you to maintain your priorities. You need to focus on doing everything you can to improve your health rather than daily cumbersome chores. But make sure to also take care of the caregivers. Make sure they eat well, get enough rest, and take breaks from their responsibilities. If they aren’t well, they can’t take care of you. You should also do what you can to make sure that difficult matters such as your final resting place, living will, and your last will and testament are taken care of so the burden of your death will be easier on the people you care about.

Make sure that you make all the right medical decisions and that you do everything that is reasonable to get your health back. And, finally, find the humor in your situation whenever you can. Laughter has been proved to help the immune system and it will lighten your load.

Stroke Facts and Warning Signs

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die. 

The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal. 

It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours. The warning signs of stroke include: 

• sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body)
• sudden confusion, trouble speaking, or trouble understanding speech
• sudden vision loss (often in one eye only) or double vision
• sudden trouble walking, dizziness, loss of balance or coordination, or falls
• sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately. Stroke is a medical emergency. 

This article was written by and reproduced with permission from HealthyOntario.com. For more on Senior’s health issues, or general health information, services and tools, visit HealthyOntario.com. 

Acquired Brain Injury Day 39

The appointment with the Neurosurgeon,which was at the Alfred was at 11:00 in the morning and we arrived about an hour ahead of time at the Caulfield to make sure that we were not late. The Nurses at the Caulfield told us that if there were any emergencies the appointment with the Doctor might be delayed or cancelled. Another patient the day before had waited six hours for their appointment, only to have it put over to the next day.

The Alfred is only 20 minutes from the Caulfield and we arrived at the Alfred about 40 minutes early. We needed the time as the directions needed to find the clinic where the appointment was going to be held, were vague and we got lost. The Alfred is not that big, but it has many departments. 

After getting directions we arrived at the clinic and checked in; we were about 10 minutes early. As we waited, a Nurse came out and told us that there might be a delay as there had been a major accident and the Dr's may be tied up. My heart sank, as I we had been anticipating Colleen getting released and to wait one more day would be very disappointing. We waited for about 40 more minutes and then people started to be called in for their appointments.

Timing is everything in life, I sometimes think. One person was called and they did not appear to be the waiting area as many people had left. Lucky for us as the person had left, because Colleen was called as soon as the staff realized the person ahead of her was not there.

We went to see the Dr. and in the meeting he was quite thorough. The Dr. talked to us about what had happened, showed us the X-Rays he had and talked about the fact we needed to follow-up with a Neurosurgeon in Canada to make sure the coiling they had used to stop the bleed, stayed in place. 

He told us that Colleen still had fluid on the brain, but that would be absorbed by the body over time but we were to watch for any severe headaches or dizziness or feelings of being off balance. 

Then he told us that Colleen had three more brain aneurysm that had been discovered through the course of her treatment. He was quite quick to point out that these aneurysms were small and there was only a slight risk of rupture. He also said it was quite unusual for a person to have more than one aneurysm and to be alive.

He was very happy with Colleen's recovery and said quote: "She had made a remarkable, remarkable, remarkable recovery." He also said that we were free to go home when we were ready.  He gave us all of the medical notes and a couple of CD's with images for the Doctors back home and then phoned the Caulfield and told them that Colleen could be discharged. We were very excited.

We left the appointment, told Danielle and Adam, then we went back to the Caulfield, where they were in the process of getting all of the paper work we would need back home for rehab together to give to us. It took the staff about 20 minutes to put everything in order for us. While we were waiting for the paperwork, we packed up and Colleen said goodbye to all of her team. They were all excited and happy to see her go, as she was one of their success stories.

Later that day, I phoned Cathay Pacific and the earliest that we could book a flight home was December 14th, so I booked that date. We went back to Rye, where everyone happy to see Colleen. We talked about the best course of action and decided that we would spend the next few days with Danielle, Adam and Ryder in Sawmill Settlement. We thought it would be quieter and it would also give Dan and his family a break. They had been hosting me for the full 39 days. It was time to give them a break. So we said goodbye to Dan, Bogs, Nikki and the kids and left for Sawmill. l am looking forward to spending some quality time with Danielle and her family before we fly home. 

It has been a very trying time, and I know we are very lucky that Colleen  had the level of care and support that we received.The kindness of my extended family in Australia and friends and family in Canada will not be forgotten. 

The issue now is getting Colleen into rehab in Canada and knowing that she has three more aneurysms. The Dr's was encouraging and said that the likelihood of  having a problem with the new aneurysms was very small. 

The fact that the risk is small, may be true, but this new fact of life is something we have to think it will take time for both of us to figure out how to live now that we know about this new risk.  Bottom line, we are heading home in 12 days and the acquired brain injury journaling is now ended. Thank you to all those who have stayed with me over the last 39 days. Life is precious and it can change in a heartbeat, so cherish those around you and be thankful for them, I know I am.

Acquired Brain Injury Day 38

The first day I have missed going to the hospital since Colleen had the Aneurysm burst. I had mixed feelings about missing the day but in the end decided it would be OK to miss one day.

Colleen was going on another shopping trip with her Occupational Therapist to find Christmas decorations. Since the day was nice, Danielle and Adam and the family had convinced me that a day at the beach with the kids would be a good use of my time. 

I talked to Colleen in the morning and she agreed that I should go to the beach. I felt bad but decided that I needed some time to relax. Tomorrow we would be seeing the Dr. and hopefully Colleen would be released and we could make arrangements to get home.

Today I want to talk about Caregivers the unsung hero's of our health care system, here in Australia and back home in Canada. 

In Australia there are 2.86 million informal carers, according to a recent  report for Carers Australia by Deloitte Access Economics – parents looking after children with disabilities and mental illness; husbands looking after wives with dementia; wives looking after husbands with failing hearts; adult children caught in the maw of elder care with its constant crises. Their ‘free’ services are worth $60.3 billion a year. 

In Canada a report in2012, showed about 8.1 million individuals, or 28% of Canadians aged 15 years and older, provided care to a family member or friend with a long-term health condition, disability or aging needs. New  data from the 2012 General Social Survey showed that women represented the slight majority of caregivers at 54%. 

The survey also found that caregiving responsibilities most often fell to those aged 45 to 64, with 44% of caregivers in this age category. Ailing parents were the most common recipients of care, with 39% of caregivers looking after the needs of their own parents and another 9% doing so for their parents-in-law. The least common were spouses, at 8%, and children, at 5%.

For the first time, the survey looked at the types of health conditions requiring care. Age-related needs topped the list, with 28% of caregivers providing care for these needs. Cancer was next at 11%, followed by cardio-vascular disease at 9%, and mental illness at 7%.

Saskatchewan and Manitoba residents report the highest levels of caregiving

The proportion of caregivers varied across provinces, with Saskatchewan and Manitoba having the highest rates of caregiving in 2012 at 34% and 33%, respectively. Also above the national average were Nova Scotia (31%) and Ontario (29%).

In contrast, Quebec had a lower rate than the national average. About 25% of Quebecers reported that they had provided care to an ill, disabled or aging family member or friend in 2012.

Other provinces were not significantly different from the national average.

Providing transportation most common form of care

The most common type of help, provided by 73% of all caregivers, was transportation to run errands, shop, or attend medical appointments. The next most frequent types of activities were house cleaning and meal preparation at 51%, followed by house maintenance and outdoor work at 45%.

Some other tasks were provided by a lower proportion of caregivers, but were done more frequently. These tasks (including medical treatments and personal care, such as help with bathing and dressing) were provided by less than 1 in 4 caregivers. However, two-thirds of those who performed these activities did so at least once 

Impacts greatest for caregivers of children and spouses

The survey also examined the psychological, financial and employment consequences of caregiving among those who provided 2 or more hours of care per week. At greatest risk of negative consequences were caregivers of children and spouses, reflecting their greater intensity of care.

About half of caregivers providing care to children (51%) and spouses (46%) reported at least five symptoms of psychological distress, such as depression, feelings of isolation and disturbed sleep. This compares with 30% of those caring for their own parents and 8% caring for a grandparent.

In addition, 34% of those caring for their child and 33% of those caring for their spouse had to consult a medical professional as a result of their responsibilities, compared with 18% of those who took care of their parents. Caregivers of children or spouses were also more likely to sustain an injury while providing care.

Nevertheless, about 9 in 10 caregivers felt that the experience of providing care was rewarding. Moreover, 7 in 10 also expressed that their relationship with their care receiver had strengthened over the course of the previous 12 months.

One in five caregivers receive financial support

In 2012, 19% of caregivers received some form of financial support. Help from family and friends was the most common at 12%, followed by government programs at 7% and federal tax credit at 5%.

Those caring for their child and spouse received the most financial support from governments. In 2012, 30% of caregivers of children received government financial assistance, compared with 14% of caregivers of spouses and 5% of caregivers of parents.

Even though they received the most support from governments, 28% of those who cared for a child and 20% of those who cared for a spouse experienced financial difficulties. This compares with 7% among those helping their parents.

In addition, 52% of caregivers of children, 42% of caregivers of spouses and 28% of caregivers of parents said that they would have liked more help than they received, financial or otherwise.

Acquired Brain Injury Day 36

Sunday and another good day. We arrived  at the hospital about 11:00 AM as Colleen had some meetings with her weekend team earlier in the day. From our explorations of the community the weekend before, we knew that nothing much was  open in the few blocks surrounding the hospital. We wanted to go for lunch, so Adam volunteered to take us for a drive. 

We thought a ride would be a fun thing to do as it was a nice 25 degree day (72 degrees on the old Fahrenheit scale). We drove around the area and then we drove down to St. Kilda beach and found a place to park. We wandered into Luna Park and the beach.

The beach was crowded with swimmers, surfers and people going for walks. We strolled along the beach, found a playground where Ryder could play and sat and watched him. We then noticed that there was a street market up on the road about a block from the playground. 

So we went to the street market and explored the stalls. It was very hot by this time, so we wandered down and everyone had an ice cream cone at  7Apples Gelato and went to lunch at a Mexican Restaurant called the Amigo's on Acland Street


The food was great, we sat on the patio and Colleen enjoyed watching the stream of people. We stayed in the area, walking and enjoying the day out for about six hours, but I could see that Colleen was getting tired, so we headed back to the Hospital. When we arrived, we went back to the playground and Ryder played for about a half an hour and then we took Colleen back to her room, where she went for a nap and we went back to Rye.

Another good day, I am very optimistic about the meeting with the chief Neurosurgeon in charge of Colleen's case.

Acquired Brain Injury Day 35

Saturday was a good day, Ryder, Danielle, and Adam came to the hospital with me and when we arrived, Colleen was ready to head out. Adam and Danielle liked the new room where Colleen had been moved. Colleen gave us a tour of her new ward, and then we went down to the Cafeteria and showed Ryder the play area that the hospital had for children who were in for rehabilitation. There were no children in the play area so at first thought it was locked but it was only secured and once we figured out how to open the gate, we went into the playground.

Ryder played for about two hours in the playground while we watched, drank coffee and played with him. After two hours of play we decided to go for a walk up to Glen Huntley Road to have lunch. We had lunch at a small restaurant. The food was delicious and then we walked looking at some of the shops for Christmas present ideas for Ryder and the family.

Colleen appeared to be back to her normal self and we all were excited about the prospect of her getting out of the hospital on Tuesday. We made plans that if she was released, I would try to get a booking on Cathy Pacific, asap so we could get back to Canada before Christmas. 

Colleen was not happy that we had to leave at 6:00 but Ryder was tired. Colleen was disappointed but she understood that she was staying for her own good (which was a positive sign). Another good day and one day closer to being able to go home.

Colleen did get in trouble after we left for breaking one of the rules of the hospital, which was caused by lack of impulse control. My hope is that the rule breaking will not be enough to delay her release. Lack of impulse control is part of the Acquired Brain Injury and one that has to be monitored in this phase of recovery.

Acquired Brain Injury Day 34

The week end is coming upon us and it will be good for Colleen to see the family. It was a day of meetings with her team to discuss progress. We met with the Speech Pathologist who was excited about the Cognitive test Colleen had done and her high score. 

We met with the Occupational Therapist who was happy that the management committee had approved the design ideas Colleen had put forth and the two of them set up a shopping day on Monday. 

The Social Worker talked to us about her efforts to contact Colleen's previous Neurosurgeon  at the Royal Colombian, but she was having problems because of the time differences. We let her know about the nearest hospital to us and she was going to contact them on Friday (Canada time) Saturday her time to see if there was a rehabilitation program closer to us. 

The other news is that she was moved from the bed she was in Bed 35 in the high security/dependency unit, to Bed 19. Bed 19 is in a more open unit. By more open unit, I mean she had more area to move around in access to the eating area for patients and an open garden in the outside space.

What struck me is that the team is getting Colleen ready for transfer to the BC system and they were working very hard to get all of the components in place so the transition would be easy for Colleen. 

We went for another walk  this time down to Glen Eira Road and stopped off at a Bakery and had a coffee and explored the Glen Eira Council Gallery. After all the meetings and b the by the end of the walk Colleen was tired, so when she went back to her room, she went for a nap and I left. 

Another good day and another reason to be optimistic.

Acquired Brain Injury Day 33

Today was Colleen's birthday, and it was another good day, Colleen enjoyed the cupcake (It was not Strawberry but it was fruit) and the cards she received today. She had been working on the plan to decorate the ward and she had completed it the night before. 

In her meeting with her Occupational Therapist, she had given the plan and the managers of the ward, looked at the plan and had approved the plan. This made Colleen happy. Colleen had also completed a cognitive skill test and had received a score of 94%, which I thought was great as did her Speech Therapist. 

Colleen's team at the Caulfield was putting together information that would be used by the Chief Neurosurgeon to help determine if she could be released on the 2nd of December. Things were looking up. Colleen was responding well to her therapies and was able to control her anger and frustration at not having full freedom.

We went for a long walk and saw more of the community, and we had lunch out rather than having the hospital food. The food was not bad at the hospital, but it gave a sense of freedom to be able to have lunch out.  All in all a good day, we have moved forward with no steps back at this point. Life is good.

Acquired Brain Injury Day 32

A good day. Colleen was in good spirits, the day was sunny and her appointments with her team had gone well and were finished by the time I arrived at 10:30. So we went for a walk up to the main street and looked in the shops for Xmas stuff that could be used to build the decorations for the ward.

We went back to the Shook Store on Glen Huntly Road. They carried a wide range of imported products and food stuff. There were two older men working and I introduced myself and asked about the name of the store. I was told that the name meant shop or market in Arabic culture.

The Shook store opened in 2013 and has served the Caulfield community since then. One of the men I talked to was Jewish and he told me about his family and that he, his Dad, his family and his Uncles and Aunts had survived the Holocaust. He told me that after the war, his family wanted to get as far away from Europe as they could. Some of his family went to Western Canada, some the Western United States and some to Australia and New Zealand. 

We talked about what he saw as a culture of intolerance that was building up in Australia against Muslims and Jews and thought that the political leaders were building up intolerance not harmony. He was worried about what would happen if the trend continued. 

He asked me if the same thing was happening in Canada. I told him that I did not think so, but that the Conservative government did have a base that was racist and intolerant but my hope was that Canadians in the majority would prevail. 

He was not sure as he and his family had seen the same kind and level of intolerance build up in Germany prior to the war. We had a good discussion but I noticed that Colleen was getting tired, so we made our excuses and walked back to the hospital.

I asked Colleen what she wanted for her birthday and as expected she wanted to leave the hospital, but since that was not going to happen, I asked here what else and she told me to bring her a strawberry cupcake.

I agreed and we talked about the idea of having a bigger celebration when she was discharged. She thought that was a good idea. I had brought her phone and her charger and so she had a small sense of freedom, in that she could phone people. In addition, the lounge area which had been flooded in the recent storm was open.

I was hopeful that Colleen would be discharged on the second and that we would be home for Christmas

Acquired Brain injury Day 31

One step forward, two steps back. The frustration of being kept "locked up" is reaching a boiling point with Colleen, She is frustrated and it was not a pleasant day. 

The day was filled with appointments, so we could not go out for a walk, as well it was cool and there were frequent showers, so going for a walk outside of the hospital was not going to happen as I did not want to risk another infection. 

Colleen's memory and her sense of time is returning very quickly, but that is adding to the frustration. She seems to think that this aneurysm is the same as the two she had in 2005. 

In 2005 the aneurysms were found and clipped before they burst, while this one was found and coiled after it burst. Because she cannot yet remember her time at the Alfred and can only remember about a week at the Caulfield she thinks she is ready to go home.

So after a day filled with heavy emotion, I left to walk to the Tram station, about 5 minutes into my walk, the skies opened up and within a minute I was totally soaked. I am from Vancouver BC and while it rains a lot, many of us who live in Vancouver, do not see the need to carry an umbrella, I was one of those who do not carry an umbrella. I paid the price for that today. 

The ride back to Rye was not pleasant. Later that night at Rye, Danielle phoned and said they were coming down for the weekend and that she would stay for the week. This is good news as I think it will help Colleen to see Ryder, Adam and Danielle to move her out of her frustration and anger. I know that the anger and frustration are part of the after affects of Acquired Brain Injury and that this hopefully is a phase that she has to get through on the road to recovery. 

Colleen has her birthday coming up in two days, but I think we will have a minor celebration on her birthday and have a big celebration when she is out. It was confirmed today that Colleen will be seeing the head Neurosurgeon on December 2nd and if everything goes well, she will be discharged and we will be clear to fly home. Fingers crossed.

Acquired Brain Injury Day 30

One month and things are looking better. 

I want to talk about support today. Over the past month I have been told many times by the Nurses and the staff at both hospitals that Colleen will not remember and that I do not need to come in every day to see her. I know these people are not heartless and probably have my best interests at heart. But I am a big believer in supporting those in need.

When my mother was dying of Cancer, I went in to the hospital everyday for over nine months to see her, I believed that my visits cheered her up and made her suffering more tolerable. When I see Colleen, I know she will not remember the day to day exchanges that we have, but I know that for the time that I am with her, she is better. 

We, as human beings, are social creatures, we need to be with others that we know and trust. When we are with those we know, and trust we feel safe. The two outbursts in the ward this last week, were, in part, caused because the people wanted to leave and go home. 

Home was a place where they felt safe and where they believed they would be cared for by those they loved. The hospital setting is a safe place, but you are not surrounded by people you care about n a meaningful way. The staff is caring but in a professional manner, not a personal manner. 

When Colleen was first at the Alfred her unit was on the second floor and to gain entry you had to talk with a receptionist who would check with the nurse and then if it was okay you would be buzzed into the ward. The waiting room for the ward was quite big and was always half or three quarters full. 

For two weeks as I walked through the waiting room, I could hear snippets of conversation. When people came in, it was because a loved one was in very serious condition and could die.  What stuck me was the conversations and the pain was the same for everyone. I started to notice patterns in conversation.  The conversations centered around a few topics: "How or Why did this happen?" "I need to let (fill in the blank) know, how do I do that?" "Everything will be fine, (fill in the blank) is in good hands" "Are you okay, is there anything I can do for you?"

When faced with the prospect of the death of a loved one, people needed support and they received it. I began to see the same people every day, and one day I had a conversation with a woman whose son was in the ward. She was hopeful about his recovery. I saw her for about three days in a row, then she no longer showed up and I hoped for the best. She saw me about a week later and told me her son had been moved to a new ward and was heading to full recovery. She also said her prayers were with Colleen.

During the last month, I have been in constant contact with my brother and other friends, and they gave me the support I needed to overcome some of the doubts I had. I also had support from my family and extended family in Australia without which I would have fallen apart. 

Because of the support of family and friends, I  am able to face the challenges that we are currently undergoing. I know that Colleen is stronger and getting better because of the support she is getting from her family. We are also grateful for the prayers and good wishes that people back home are giving to us. The support means a great deal to the both of us. Thank you

Acquired Brain Injury Day 29

Since the infection cleared a day ago, progress has been fast and surprising to both the team and to me. We had been taking two steps forward and someways three steps back, but now it feels like we are not just taking steps forward we are starting to run. 

When I arrived in the morning, Colleen had her coat on and was ready to go out for a walk. Her appointments for the day had finished. I had arrived around 11:00 as I knew her appointments with her Physio and Speech Pathologist were in the morning.

We decided to take a long walk and explore some of the neighborhood, but as this was a Sunday, many of the shops were closed. The Synagogue was open and when we walked by, the worshipers were just leaving, and the street was full of families walking.  Some were friendly and responded when we said hello, but many were not. 

There was a shop called "The Shook" which we noticed but it was closed, so I told Colleen that tomorrow we would go into the shop and ask about the name and see what they sold. As part of the rehabilitation plan, Colleen had been given/volunteered the task of helping the nurses set up a Christmas Display in the Ward. As the ward had just opened in October, this was to be the first Christmas for the staff and patients in the Unit, and they wanted to do a good job.

Colleen had worked, as a hobby, in the Theater as an Assistant Stage Manager and as a Properties Manager as well one of her hobbies is Stain Glass. She is a very creative person, so the Occupational Therapist asked Colleen if she would help. Colleen agreed, as much to get some thing to do. So when we went on our walk we spent some time looking at Xmas decorations.

I cannot imagine what it is like for Colleen at this stage of rehabilitation, she believes quite strongly that she is fine. Her short term memory is returning although she does get confused from time to time. She looks out of the window and sees trees that are similar to home, and thinks she is at home. 

She knows she has had a brain aneurysm but she thinks it happened a few days ago. She knows she is in the hospital but thinks she has only been here a few days. (About the time she beat the infection). She does remember parts of the trip and every hour it seems that more of the short term memory and her cognitive skills are coming back. This is leading to a very high level of frustration with her situation. 

The man who had the meltdown few days ago, seems fine now but he constantly talks with Colleen about the fact he wants to leave and he cannot. This reinforces Colleens eagerness to leave and to go home. When she was at the Alfred, she was living in the moment and when I left for the day, I think she forgot I had been there, so leaving was not a big issue.

Now when I had to go it was difficult as Colleen knows I was there and she knows I am going and will not be back for a time. (I think her sense of time is returning and time is probably going very slowly for her). She also believes that I am going to enjoy myself when I am away from her. The fact is that I still travel a little under three hours each way and when I get back I eat, then go to sleep and then am up again and back to see her. Not much fun is being had by either of us.

We will be seeing the chief Neurosurgion on the 2nd of December and I am hopeful with the progress happening so fast that Colleen will be cleared to fly and we might get home for Christmas.

Acquired Brain Injury Day 28

Today was a so so day, we had some good conversations, and we had some frustration play out, but we were given permission to leave the grounds. Each weekday is a busy day for Colleen, she has appointments with all of her team as they work towards a release date. We were able to squeeze some time (about an hour) where we went for a walk through the community. 

The Caulfield Hospital is in a residential area about eight blocks from a commercial Road that has shops, and coffee shops. The area is middle eastern with many Jewish, Egyptian, and Turkish shops among others. A very eclectic neighborhood and Colleen and I enjoyed walking and looking into some of the shops. Our time was limited because of the structure of the Appointments.

When we went back to the ward, there was another meltdown by a patient. This time it was the lady who thought I was the devil. Again we were shut in our room, while her team successfully calmed her down. 

Colleen said that she had trouble sleeping because there was a great amount of noise in the ward, however inability to sleep is a one of the consequences of Acquired Brain Injury, so I am not sure if the noise is the only reason for lack of sleep. 

She still was a bit confused and kept insisting the ward staff kept moving her room. This was not the case as her room had not changed. However I could see her confusion, because every time we left we had taken a different exit and when we returned we had take a different entrance.  

Colleen appeared to more alert and her Physio and her Speech Pathologist were pleased with her progress. The only problem was that Colleen had grown tired of the tubes in her and she had, the night before, pulled out the needle in her vein and she also had pulled out the tube in her nose that was being used to feed her. 

The nurses were going to reinsert the tube and the needles when the Dr. decided that Colleen had been eating and drinking enough and the medication was working on her infection. The medication could be given orally not intravenously so they decided to not put back the tubes. This was a relief to me and I think to Colleen. 

Colleen  is still frustrated with her lack of freedom, and I suspect lack of stimulation but the good news is that she is taking the frustration out on me and not the staff. I think the other two meltdowns were caused by the fact that neither of the other patients had received any visitors for the time I had been into see Colleen. 

I think the inability to vent may have caused the other patients melt downs. Colleen had me to vent to and as long as I did not take her venting personally then I was fine and she could feel that someone was listening. 

So in my mind, today was a good day and we are moving closer to being able to go home.

Acquired Brain Injury Day 27

The tests had come back, the Doctor said as she explained that Colleen actually had contracted two separate infections and that the antibiotics she had been given worked only on one of the infections. The Doctor said that they had started Colleen on another treatment the night before that the Dr. hoped would get rid of the second infection. 

This morning the Dr. told me that the change in medication, appeared to be working and Colleen was able to respond to questions. Colleen had a good meeting with the Speech Pathologist where Colleen talked about Ireland being one of her favorite places to visit and she went on to explain why she loved Ireland. 

Colleen also went to another meeting with the Occupational Therapist which went well this time, according to the Therapist. It was a tiring day for Colleen, she still was a bit confused about where her room was located. Luckily Adam's Mom had sent some beautiful flowers and those were allowed in her room. Her short term memory was back enough for her to know that she had the room with the flowers. 

There was a lock down as well today, it happened just after Colleen came back from her Occupational Therapy session. We had been given permission from the Dr. to leave the war--not the hospital so we decided to walk down to the cafeteria. However, when we were talking about leaving, the nurse closed the door and told us not to leave the room.  

We heard shouting and banging,which upset Colleen, so I looked out the door to see what was going on. The 40 year old man who I mentioned a day or so ago, who wanted to go home was having a meltdown. There was a team of people I am assuming his medical team was there talking to him trying to get him to gain control. From what I could see, he was not putting any of the staff in danger, but he was perhaps putting himself at risk. 

I also noticed that behind the team there were about six big security guards, but they were keeping out of sight of the man. It took about 15 minutes but the man was finally calmed down by the staff and taken back to his room. Colleen and I then were allowed to leave the room and went for a coffee. Colleen's sympathies were with the man as she too wanted to go home.

By 4:30 Colleen was tired and she went for a nap, I had brought her phone and left her with it and said that she could phone me. She phoned about 8:00 that night and left me a message to phone when I woke up. I phoned her back and she had fallen asleep but she thought she had slept for 14 hours when she had only slept for 3. She also phoned her mom and talked to her.

Another day with more forward than backward movement so I was happier.

As an aside, it was interesting and frustrating that the experts when they were talking to Colleen, tended to look at me for answers, I know that Colleen noticed this behavior, but did not vent or point it out to the staff. I thought that was a great step forward in frustration and anger management. 


The experts, I don't think, were deliberately looking to me for answers to simple questions, but I think it was a habit. Some of the patients perhaps did not have the cognitive skills needed to respond.

Acquired Brain Injury Day 26

Another setback today, it has been about 25 days since the Brain Aneurysm happened and I am tired, frustrated but was still full of hope. However, when I came in today I was told that Colleen had been very sick to her stomach throwing up at night and she also had diarrhea the night before and was still sick. The nurses were working with her and monitoring her water intake as well as her medication. 

She spent most of the day sleeping and so it was a quiet day. My hope is that they will figure out what is going on with the infection as they took more blood and had sent it off to get more tests done.  Colleen had not eaten well for a couple of days and they were concerned about this aspect of her health and recovery. Because she was not eating so they had kept the tube through her nose to feed her at night, so she would get the proper amount of nutrition. 

I stayed with her for the day and read while she slept. I also got a chance to observe the other patients. There was one lady who thought I was the devil and appeared to going through a whole range of emotions from being very depressed to being giddy all within an hour.

A young man probably in his 20's was allowed out only with a male nurse with him at all times, another man in his 40's who appeared to be frustrated with his lack of freedom, he wanted to go home. His short term memory was not good as every time he saw Colleen, he asked who she was. 

I thought we had made some progress but it felt like two steps forward and three step back. I realized that she would not make any progress until the infection was cleared up. I hoped for Colleen's sake that would be soon. 

I was finding it hard to deal with for what I saw were more steps back then more steps forward. I was fortunate that I had people hat I could talk to both here in Australia and back home. 

Having a support group is important for caregivers. With the ability to take a small break (going out to dinner with friends, watching a Cricket game, or just relaxing) from the tension has allowed me to keep my sanity and to take care of myself, so I can be there for Colleen.

Acquired Brain Injury Day 25

I cannot say enough good things about the Alfred and the Caulfield Hospital. The Acquired Brain Injury Rehabilitation Center was set up to ensure that people recovering from severe brain injuries have the very best chance of a meaningful recovery. The Service model they followed and which appears to be working is  guided by the following key principles:

• A focus on early transfer of patients from acute hospitals to rehabilitation
• Comprehensive interdisciplinary, evidence based, model of care focusing on person centered rehabilitation to achieve functional goals
• Integrated inpatient and community rehabilitation programs with patients receiving ongoing therapy and care in the least restrictive environment to promote independence
• Community rehabilitation service providing long term management and support, in partnership with local services, focusing on lifelong, evolving needs of people with an ABI.
• Extensive family/ carer and patient education and engagement in the process.

The service is underpinned by a culture of patient safety, excellence in service delivery and continuous quality improvement through the use of current, and emerging, evidence in clinical practice. An active research program will also underpin the service model, ensuring ongoing service evaluation and the development and translation of new evidence into practice.

I may have mentioned this in an earlier post but it bears repeating. The Alfred is home to the busiest trauma center in Australia and each year offers high level acute care to thousands of patients who sustain head injuries, as well as acute care to patients who have experienced stroke or brain injuries from other causes. Caulfield Hospital, as a specialist site in rehabilitation, has also long-provided support to these patients that leave the Alfred.

Colleen was not very well when I saw her today, she was still sick from the infection and she had not slept well. The move confused her and the new surroundings were leading to a high level of frustration. She had a meeting with the Occupational Therapist which "did not go well", according to the Therapist.

One of the impacts of Acquired Brain Injury is Poor frustration tolerance and anger management control, which were in full evidence today. I can still see signs of progress but there are some setbacks  

One of the signs of progress was that she knew I was leaving and she couldn't leave. She wanted to have her freedom and was frustrated by the restrictions of movement she was under. I am sure she did not see it as an improvement but while at the Alfred she was not aware enough of her surroundings to know if I was there or not. So I take this as a good sign.

Acquired Brain Injury Day 24

A day of consultation. It was a busy day, Colleen and I met with the her team leader, her Doctor, her Physiotherapist, her Speech Pathologist,  and her Social Worker. 

The Dr. informed us that Colleen still had the infection that she had contracted when she was at the Alfred, and it appeared that the antibiotics were not working. This was a problem and it was affecting her ability to recover, so they would be taking more blood and doing some more tests to see what they needed to do to combat the infection.

The meeting with the others were introductory each person came by Colleen's room during the day just to meet with us and explain their role and how they would be working with Colleen over the next two to three weeks. The consensus was that Colleen should only need two weeks or more, of rehabilitation.

The Caulfield Acquired Brain Injury Ward opened in late October and has  42 single-bed rooms, designed to be comfortable for patients while undertaking rehabilitation as an inpatient. 

This center was the State of Victoria’s first purpose-built center of excellence in brain injury rehabilitation. It was built for the purpose of providing specialist treatment for patients with acquired brain injuries – from early stages of care through to rehabilitation and return to the community. 

The unit was set up to support rehabilitation and to meet the needs of patients with severe brain injuries resulting from trauma, stroke and other medical causes of acquired brain injury. At the time Colleen was admitted there were less than 20 patients in the ward.

Colleen had a room right across from the nurses station, as she was in a high dependency ward and she was deemed a wanderer, so they needed to keep a close eye on her. There were only four other patients in the ward with her. Each patient had their own room. No outside stimulation was allowed in the ward, which meant no radio, no TV, no newspapers or magazines.  The ward was secured and you could only get in or out by being buzzed in or out by the staff. The ward was monitored by CCTV at all times. 

I soon realized that the people in this particular section of the hospital, were in the most vulnerable positions, medically. So the Caulfield medical team were still concerned that Colleen could have a setback.  

Patients could only have a maximum of two visitors at one time and the visiting hours were strictly controlled. The patients were well cared for but had no freedom, which made sense as they had no short term memory. The fear was that if they wandered off, they could not know where to go or how to get back. If they wandered out of the hospital, they might not remember how to get back.

Colleen's short term memory although it was still not all there, I thought, was returning, as she was at least aware she was in a hospital. I had been asked the day before to bring clothes for Colleen as the feeling of the team was that the patient should be dressed as they would normally dress day to day. 

The only problem that I had was when she was dressed Colleen wanted to go home. She still thought, from time to time, that she was in Canada. Every time she looked out the window of her room, she saw streets that looked like Canadian streets and trees that looked like Canadian trees (Beech, Elm, Oak), so in her mind we were in Vancouver.

After the day of consultation I believed she was in good hands, my hope was that they would be able to cure the infection sooner rather than later.