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Hemorrhagic Stroke

My aunt had a hemorrhagic stroke on 8/24/06. Her right side is paralyzed, she cannot speak (except for: yes, no, okay, oh God, alright, stop), she has a PEG and a PICC Line, swallowing is weak, she seems to be in excruiating pain nearly constantly, has difficulty evacuating, seems to be in a severe depression.

She suffered a couple of set backs (pneumonia, bowel blockage, and now the pain) which slowed up her progress. She is currently in a sub-acute facility as the acute one seemed to be a bit much for her. The crying and anger really is upsetting for us, my aunt not normal behavior for her. The worst part of watching all this is not knowing what to do to make it better for her.

I have a few questions, if anyone could help I sure would appreciate it.

1. She seems to have severe pain but where we don't know. She can't tell us. I was wondering if any of you have an idea what it could be? Neuropathy perhaps? She is on vicodan and helps somewhat.

2. Her progression is very slow, most times at a stop, is this usual?

3. Is there anything we (her family) can do to help bring back her speech? We tried getting her to write - but the letters she writes don't spell words. We tried making picture cards.Is there something we can get to help her to communicate better? How about those magnet letters the kids play with?

10 Responses
144586 tn?1284669764
Vicodin sometimes contributes to bowel blockage by inhibiting peristalisis. Sometimes the lost peristaltic action is due to the stroke.  Presumeably, you have been evaluated by a stroke specialist. I have no idea what caused your bleed, however a common cause is simple vitamin k deficiency. Vicodin (and all the opiates) are not good drugs to be on for the long term. Sometimes these things get better. Only time and the life-force will tell.
Avatar universal
To get the best answers to your questions, please talk with her provider, make a list of questions and don't leave until you get your answers.

1. She seems to have severe pain but where we don't know. She can't tell us. I was wondering if any of you have an idea what it could be? Neuropathy perhaps? She is on vicodan and helps somewhat.
--Pain could be real or referred, could be caused by too many numerous things to mention.   I think you meant to ask how to get her to tell what/where her pain is.    try giving options/choices to locate the discomfort.   as for the vicodin, if she is on a narc,should be on a stool softener as well, this is usually prescribed routinely.  

2. Her progression is very slow, most times at a stop, is this usual?
--everyone heals differently, and no one can predict progress.

3. Is there anything we (her family) can do to help bring back her speech? We tried getting her to write - but the letters she writes don't spell words. We tried making picture cards.Is there something we can get to help her to communicate better? How about those magnet letters the kids play with?

--ask speech therapy for exercises to do with her to improve speech.  (most exercises are ka,ka,ka, ma, ma-- similar to teaching babies to talk) recite alphabet, counting, anything to keep the vocal chords moving so they can strengthen.
Avatar universal
Caregiver & Hopeful Nurse

Thanks so much for your responses. I appreciate the info and time you took to respond.

The good news is they are giving my aunt stool softeners that will hopefully avoid her getting blocked again. We can (sometimes) get her to tell us what is hurting by asking about each body part individually (she can say yes or no). And thanks for the info on helping her with her speech - we didn't know where to start. Now the trick is to get her to cooperate. The biggest problem we have now is the pain she is suffering and depression.

We just found out in addition to the pain, she is severely depressed - which has become a big problem because she cries and yells constantly & isn't cooperating with the therapy (for the last few days). We found out that Kessler (Institute) was to have started her on anti-depressants - but forgot! (Unbelieveable!) So the new sub-acute facility started them yesterday. Hopefully this will help.

Thank you again, you have no idea how much I appreciate your input.

Avatar universal
it's great that she can answer yes/no.   i strongly suggest that you try choices instead--this will help her talking.  for example, ask if her upper body or lower body hurts.  then left or right side, i/m sure you see where i/m going with this.  good luck.
Avatar universal
Thank you again. I hadn't thought about that (asking 'option' questions). I'll give that a try.

As a little update, she has been back in the hospital the past week. She was impacted and vomiting - the food (from the feeding tube) had no where to go but 'up'. Then she had a reaction to the morphine they gave her. And the day before she was sent back to the hospital she wrote the word "pain".  They've cleared up the digestive problem and changed the type of food they are giving her through the feeding tube...this supposedly will be easier for her to digest (I sure hope so, couldn't bear to see her go through this again).

Yesterday she had the best day I've seen her have since the stroke. Completely out of pain, comfortable and at ease and laughing! She even said a few more words. I pray she is turning a corner and will continue to improve.

Thanks again for your help. It's very much appreciated.
Avatar universal
My husband had a bleed which caused a massive stroke 4 years ago. I have searched for facilities and answers this whole time.  I just found a Brain Rehab in Benton Ark.  The name is Timberidge they only treat brain injuries.  I thought I would post this here so others who have spent hours looking for somewhere to get help can have a name of a facility.  
My husband had a aneurysm on the right side of his brain. The anuerysm caused a stroke which paralized him on his left side.  When he woke up he instantly felt pain.  Which I thought was a blessing.  It turns out that having feeling in the left side of his body isn't a blessing. It is nerve pain which for him never goes away.  The stroke caused damage to the part of his brain that tell the body to hurt.  He takes darvocet, Gabapentin, and Tizanidine hcl for nerve pain and muscle spasms. Darvocet is a pain pill, Gabapentin is used for seizure & or nerve pain. and the Tizanidine is used for muscle spasms and to help him sleep.  None of these work completly for him but they do help.  Remember it is 2days forward 1 day back at all times. But eventually with alot of work and dedication they can improve. I know that every case is different but there wasn't a dr. or nurse who thought my husband would ever wake up or ever be able to function, talk, or have any cognative thoughts. His bleed was for over 4 hours and his stroke was instant.  The majority of the right side of his brain is either gone or dead.  Everytime we have a ct scan they ask me how he could be so amazingly normal to talk to.  He was a baby when he woke up and through alot of work we taught him ballance, to sit up, smile, walk, talk, swallow, eat, laugh and use the remote to the tv.  (which now we regret)  Be patient with her, my husband woke up scared and mad because he couldn't get anything to work like it use to.  Their brains are still short circuited and it takes time to get things going in the right direction.  Other parts of the brain start to pick up where the other side left off.  With therapy they can retrain the brain.  Fight for therapy!!! and with insurance it is a fight.   Mike doesn't remember anything for the first 2 1/2 to 3 months after he woke up.  Which is a blessing.  Challenge her don't baby her.  I babied my husband and now he thinks I should do everything for him.  It is so easy to do everything for them because they hurt so bad, but what I have realized is that I have become his crutch. He doesn't want to do anything for himself because he has me.  This has been the most rewarding thing I have ever done and the hardest most exausting thing I have ever done.  But I know I would do it all over again because he is worth it.  Mike was 44 and I was 33 when this happened.  He is a miricle and a blessing even on the days I think I can't go anymore  I still thank god for his life. Always remember to count your blessings every day even if they are as small as a dust mite.  God bless you all.
Avatar universal
Hi Jennifer ~

What an encouragement your post was. Thank you so much for taking the time to write it. It gives me hope that my aunt will soon regain some more speech and movement. She is out of the hospital (again) and back at the nursing home and continuing rehab.

Like the nurses and doctors you've dealt with I too am amazed by your husband's recovery so far...what you described him going through initially sounds like it was a worse bleed than my aunt has had. And to hear about his improvement is such an encouragement (thanks again).

God bless the two of them and may they both continue to recover (preferably quickly).
Avatar universal
Hello again,  Well you have to love insur. they denied the rehab for my husband. Now our dr is trying to have it seen before the board. If they turn it down then we will pay the out of pocket expense as long as we can. It should run 700-800 a day and should last about 4 months 100k. I have seen a huge differece in him since they came to evaluate him. He is so excited. This is the first time we have had hope for him to get the therapy he needs full time. Insur thinks he has progressed to far.  It is kind of comical that someone who sits behind a desk can say they have progressed to far. I wonder what determines "progressed to far" when you can't dress yourself, stay by yourself, get your own meds, drive to the Dr. or sign doc's that could change your life.  What part of brain inj do they not understand and would they fell the same if it was them in this condition and being told they had progressed to far for help. This is a on going battle for all of us. Be strong and fight the ins co. They do bend....sometimes   LOL

Before you start paying those bills for your aunt. verify the charges with her ins. Sometimes the hosp. bills the patients for items the ins makes them write off. Or the hosp miss coded it,if they send it back in with the correct code the ins will pay. We found so many mistakes in billing, they tried to make us pay for. I finally got a girl who I asked for everytime, she new me and I new her. It helped having the same person help you because they usually will remember you after awhile and will try their best to get things fixed when there is a problem. Also check with her ins co. they can assign a nurse from the ins co. to your aunts case. We did not know this until 3 yrs after his stroke. All I had to do was call her when he needed something and she went to work on her end to get it approved. This bypasses a dr visit. Which saves you money and a long wait at a dr. office.

Hope your aunt is getting better. Tell her to keep up the good work. She can get better. Hope this helps
God bless you guys.
Avatar universal
And if you can't manage to pay for that good rehab place in Ark, and are up to doing a home program, check out the Vasa program at www.brainstrokes.com
My husband continues to improve doing this program.
Avatar universal
Well Ins denied my husbands rehab.  We have put in for a appeal but it will probably be denied also.  I now have to decide if I can afford to send him to the facility on my own.  I hope your aunt is doing ok. How is her progress?
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