After a stroke, which is usually confirmed with a CT Brain Scan, persons might be left paralysed, may have speech and swallowing problems or psychiatric problems such as depression or anxiety. Complications from stroke can also include pneumonia, impaired vision and loss of independence. It can be scary for the patient and their family, but recovery is possible with proper support. (Check out this quick guide to a stroke to learn more about what a stroke is, the symptoms and what happens afterward).
For many recovering stroke patients, short term goals would be to improve mobility and functioning, and to make sure that swallowing and speech problems are addressed. Long term, most persons wish to get back to their regular lives as much as is actually possible.
How can stroke patients and their families achieve this? The answer is stroke rehabilitation as well as physical aides to help the person function.
Unfortunately, many hospitals in the Caribbean lack the resources to provide proper rehabilitation support to stroke patients in the weeks, months or years after a stroke. However, private resources are available if you are willing to seek them out.
Good healthcare requires a multi-disciplinary approach which means that a team of people is needed to help the person. Stroke rehabilitation is no exception. This kind of team may include a Physical Therapist, Occupational Therapist, Neurologist or Psychiatrist. Family members will also need to get involved to arrange visits, assessments, ensure finances are managed, and offer insight on the patient to the health professionals. We have some highly qualified professionals in T&T and the Caribbean. For example, Total Rehabilitation Centre TT or the Stroke and Diabetes Centre in Trinidad may be a good start. Check out our post about the different kinds of professionals available, and scroll down on our 50+ Resources Page for useful contact info in T&T, Barbados and St Lucia.
You may also need to use physical aids like a wheelchair, a walker, foot brace, or grab rails. These are available from medical equipment companies, or you can find out if you qualify for it from your local social welfare department via a grant. Some stroke patients with communication problems can also use technological devices like the T&T made Communicare app, which allows patients to communicate with their family members and caregivers via a smart phone or iPad.
Other options are assistive technology devices which allow people to be more independent and to live safely. They include a wide range of devices which help persons to do everyday tasks which may now be a bit difficult for them, such as cooking safely, making a phone call, turning door handles or getting in and out of a car. These devices are available for sale on Amazon.com.
But these devices often require professionals to help persons learn how to use them successfully. Even things like a walker, which might seem simple, requires knowledge on how to use it properly and avoid accidents or falls. In this case, you can consult with an Occupational Therapist or a Physical Therapist who can help the recovering stroke patient to improve balance, mobility and independence and reduce their risk of falls. Lastly, if there are speech or swallowing problems, you can consult with a Speech and Language therapist.
A stroke can be a traumatic, life changing event for the patient and their family members. Seeking out appropriate healthcare providers for stroke recovery and rehabilitation, as well as investing in appropriate aides and devices to help the person remain independent is therefore key for the long term well-being of stroke patients and their loved ones.
Medications are sometimes necessary, but if used recklessly they can also cause a lot of harm.
First of all, they should be prescribed cautiously by a qualified doctor in that field, reviewed regularly and reduced or stopped where possible. You should be in contact with both your doctor and pharmacist to ensure that this is done. Be careful who you accept medication from. Just as a Psychiatrist should not be prescribing heart medication, Cardiologists should not be prescribing psychiatric medication. GPs are able to prescribe all medications but will seek specialist advice when they are not sure. Be careful because medications don't always make things better!
Secondly, please, no matter what Dr Google says, NEVER self-medicate, take medication against your doctor's advice or alter doses on your own. If you think you are on too much medication talk to your doctor and get specialist advice as needed. People these days think that the internet is the answer to everything (and free too!) but this is simply not true. There is a reason why we doctors need to study pharmacology for years and years and why only a doctor can prescribe. I cannot tell you how many patients I have had who have made their illness worse by taking matters into their own hands.
Thirdly, choose your pharmacist wisely and seek advice from them and not your friend who is playing doctor. Even if you are going for over the counter (OTC) drugs, remember they can cause harm too and can interact with other medications you are taking. For e.g some people take St. John's wort for depression which is a 'natural' antidepressant. However did you know that it interacts with the contraceptive pill? So women of child-bearing age run the risk of becoming pregnant thanks to this so-called harmless natural medicine. That is only one example of many. Lastly, strict pharmacists are not trying to make your life more difficult. They just take their work seriously and understand how dangerous medication can be and so will not give you medication if they think it will harm you, or without a prescription. This is the type of pharmacist you should go to!
Dementia by definition is a deteriorating illness with no cure, meaning that it will get worse over time no matter what we do. So the only thing we can do is manage the situation as best as possible.
However, if you live with the person you will unfortunately witness the deterioration right in front of your eyes, which is extremely difficult and heartbreaking to witness. No matter how much you resist, there is unfortunately no way to stop this deterioration.
Different psychiatric medications have varying degrees of success. Once the proper medication is decided for the patient, it might help ease the symptoms or slow the progress of the disease, but it will not stop the deterioration altogether.
There are also several other treatments that I often suggest, yet few people listen as everyone is hoping for a miracle pill which does not exist. These treatments are always beneficial physically and emotionally:
1. Occupational therapy to ensure your loved one remains independent and active as possible
2. Psychological therapy for family members to help to accept the situation and to learn strategies to deal with day-to-day situations
3. Psychological therapy for your loved one to help him/her deal with his diagnosis in the early stages
4. Music therapy or art therapy to help your loved engage and enjoy life as much as they can.
5. A comprehensive nursing assessment looking at the day-to-day aspects of the person's life, in order to identify and solve difficulties (e.g. eating, bathing, dressing, sleeping, behavioural problems)
6. Attending a support group to get ideas on how to manage situations or just so that you don't feel alone and isolated
Other experts that also help with Dementia care are Dietitians, Physiotherapists, Social Workers and of course other doctors such as GPs/Neurologists. To learn more about each of these, click here.
The idea when treating a person with Dementia is that it should be a team effort. We unfortunately do not have big centres such as in Canada or the US/UK where everything can be found in one place, but we are lucky in T&T to have excellent, well-trained healthcare professionals that one can go to privately. The problem of course is that it is so expensive. This is why careful planning for retirement, and investing in insurance plans are so important! There are also excellent healthcare professionals in the public sector, but you may have to ask around to make sure you get the best qualified, most suitable person available.
We should never give up on loved ones with dementia, as there is so much that we can do to make their lives (and yours) better. But acceptance of the reality of the situation is the first step. Also, acceptance of the fact that it will be very very difficult and will require a lot of work on your part might make things easier in the long run. I know dealing with dementia is hard, but don't give up!
If you have mental health concerns, you should seek help. But where do you go? How do you know what type of doctor you should talk to? Do you look for a psychiatrist or a psychologist?
If you’re unsure what the difference is, you’re not alone. What you see on TV is not reality. There are similarities, but there are important differences, too. Here’s what you need to know to decide which is right for you.
How They’re Alike: Psychiatrists and psychologists are different types of professionals trained to help you deal with mental health issues. Both are there to get you through problems. Both Psychiatrists and Psychologists look closely at your behaviour such as not getting out of bed, your sleep patterns, eating habits, and negative thoughts that might be causing or contributing to depression for example.They aim to provide you with the means to manage the issues in your everyday life.
How They’re Different:
Education: Psychiatrists are medical doctors who graduate from 4-6 years of medical school, and then go through anywhere from 4-8 years of post graduate training in the assessment and treatment of mental health disorders depending on where they train (US = 4 years, UK = 8 years, so a total of up to 14 years of training). A doctor who graduated in the British system like we have in the Caribbean has the letters MB BS, or MB BCh or MB ChB after their name. A doctor who graduated from the American system has the letters MD after their name. They all mean the same thing: a basic medical degree. Then there may be other letters after that, for e.g. in the UK the letters MRCPsych mean that the person is a qualified Psychiatrist and CCT means they have completed their training. West Indian Psychiatrists may have the letters DM after their name, which is the local equivalent of MRCPsych.
On the other hand, psychologists have a doctorate degree in an area of psychology, which is the study of the mind and human behaviour. They are not medical doctors and so can’t prescribe medication. A psychologist can have a PhD or a PsyD in clinical or counselling psychology, for example. Typically, they have gone through 7-9 years of training in total. Unlike psychiatrists, psychologists are also trained in giving psychological tests (like IQ tests or personality tests). In most countries, only a person who has a doctorate degree can call themselves a psychologist.
The Approach: Psychiatrists are medical doctors and have studied the workings of the body (physiology, biochemistry) and mind (psychology) and how medications work (pharmacology). They focus on the medical side of things. They might ask you to do blood tests, or get a brain scan or to get an ECG to check your heart. For instance, before a psychiatrist calls someone depressed, they will make sure they don’t instead have a vitamin deficiency or a thyroid problem. Once they’ve excluded physical illness and they make a mental health diagnosis, psychiatrists often prescribe you medicine. People are often afraid of medications like antidepressants, However they have been proven to work and can improve your quality of life significantly. They will also advise you to make lifestyle changes to help you to help yourself (exercise, eat healthy, get good rest, don't drink too much alcohol, don't smoke etc.). Sadly most people do not listen to this advice as they don't want to take responsibility for their health!
Psychologists on the other hand are trained to practice different forms of psychotherapy (talking therapy) -- i.e. talking with their patients about their problems and using highly specialised ways to treat their problems and to give the person the tools to manage their daily problems. It is not just talking or getting advice as you would from a friend or family member, but it is a form of treatment that is equal to medication and it takes years of training to be competent. Only some psychiatrists are trained to do this in addition to their medical treatment, but not all. It depends on their training. It is important to know whether the person you are seeing is actually trained in psychotherapy before you do talking therapy. Don't be afraid to ask!
Both are highly important professionals in treating mental illness and both medication and talking therapy have been proven to work, and to work even better when combined!
For more info on this topic, check out this interview I did with a local podcast on mental health issues in T&T:
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.