|
Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Stroke Rehabilitation in Nursing HomeForum: Neurology Forum
| |
My 83 year old mother had a massive stroke on the right side of her brain in August, 1988. After 6 weeks rehabilitation at Edwin Shaw Hospital, she was released to a skilled nursing unit in a nursing home. The first week she did great. Although partially paralyzed on her left side, she could stand and walk with maximum assistance. She could move her left shoulder, pull her left arm back and lift her left leg; her speech and swallowing improved as well as her ability to focus. Her memory and mental functions were not impaired by the stroke. When I went back to see her three weeks later (she's in AKron--I'm in Virginia)she had regressed significantly. She could no longer move her left side at all, walk, or bend over at the waist. Her speech had deteriorated and she was hallucinating. When I got a list of her medications, she was on 13 meds -- mostly blood pressure and anti-depressent medications. I had her doctor take her of Reglan, Ditropan, and Megace,and her hallucinations stopped. But I'm still concerned that she is being over-medicated and that it might be causing her to get progressively worse. I can't get the nursing home DR. to return my calls and the nursing unit manager seems to resent my questions. She's starting to loose her grip on reality. My gut instinct tells me she's not getting what she needs.All her physical, speech and occupational therapies have been discontinued because she was not making any progress. The neurologist and geriatric specialist she went to before the strokes won't get involved in advising me about her medications. She is currently on Atenolol, Prinivil,HCTZ,Ritilin, Prozac, Pamelor, Pepcid, Plavix, and Ultram, when needed for back and leg pain. I've researched the possibkle side effects of these medications and they seem to have the potential to cause many of the symptoms she is complaining about. She had symptoms of early stages of Parkinson's before her sroke; could it be causing some of the problems she is currently having? she had trmors in her right hand for awhile before and about 6 weeks after her stroke. Even though they have subsided,her right hand is week and her writing looks like chicken scratches. Am I over-reacting?
= Thanks for your questions. It always difficult to provide an in-depth comment on possible medication side-effects and interactions without knowing the complete medical history, and the initial reason for the introduction of each medication. However, given the history of a significant stroke in the past, it is of concern that your mother is currently on 3 medications that can lower her blood pressure (atenolol, prinivil, and HCTZ). Depending on the cause of the stroke, it is possible that she might have significant narrowings in her intra-cranial blood vessels, thus being much more succeptible to the side-effects of poor perfusion (of brain) from those medications. It is also of concern that all the remaining medications can clearly affect one's cognitive abilities (Ritalin, Prozac, Ritalin, Pepcid, Ultram). Regarding her "tremor" symptoms, it is certainly a problem that deserves further investigation, and its occurrence would be completely independent from the stroke. Despite your initial lack of success, a clarification regarding the medications from the Skilled Facility medical staff is clearly within what you should expect and receive from your mother's physicians. I hope this information is helpful. Best of luck. This information is provided for general medical education purposes only.
| |
