Monday, August 25, 2014

Returning to therapy!

I took three months off of vision therapy, and I returned this morning.

Before my break, my eye doctor and I agreed that I should take a break. After all, 

I have been doing all sorts of therapy since my strokes 2 1/2 years ago.I just said, "I'm just so tired."Our fourth-grader started back to school on Wednesday. 

This morning I took him to school, and he complained jokingly saying, "I just don't want to go to school!"

I told him that we both had the summer off and now we are returning to school. 
Amazing but I'm still doing therapy. I'm still "doing school." I believe I have done over 400 sessions of therapy so far. 

From kindergarten through college, I excelled in school.

But my therapy is the toughest challenge I've ever had. 

This morning returning to therapy, I did well. But now I have a massive headache which is expected.

I assume when I pick him up after school, he will say, "I am so tired and fourth grade is so hard!" It's been four days.

You have no idea.

Wednesday, August 20, 2014

Relevancy, getting back and giving back

On November 10, 2011, I wrote a blog post about sons and fathers. My son was six years old when I did that blog post.

Now he's nine.On November 10, 2011, I wrote about our son: "He  admonished me to get a different job such as a mechanic because they know how to do cool things, make lots of money, and don't have to travel."

Today, 2 3/4 years later, I am missing our son's first day of fourth grade at Sacred Heart school in Boise. I'm in Coeur d'Alene for meetings. 

I am missing him already.

It seems so normal. I hark back to when my son said I "should get a different job."
And here I am again. Is it worth it for me to strive so much to "get back" when I miss my son and my wife?

This morning, at that Idaho Governors Cup, Gov. Butch Otter sat down with me alone and asked how I was doing. His concern is so genuine. 

Six years ago at the Governors Cup in Coeur d'Alene, I left early to see my son's first soccer practice. When he checked out, I saw the governor hugged me and said, "That is what's important! Good For you!"

This week, several people expressed heart felt concerns for me even now. I am grateful and so many ways. 

But for the most part, most of these attendees think that I am just fine. After all, I am attending the Governors Cup representing thing the College of Western Idaho, laughing like I used to, traveling, and people say "Mark Dunham looks great (i.e. not paralyzed)! And his speech came back! Wow! He is really back! He seems so normal now."

My old normal self and my new normal self is completely different.

Seems it was eons ago when I wrote that post. So much has changed: Strokes, seizures, finances, disability, 20% of my brain is gone, the death of my parents, Aphasia and Apraxia, reading and vision issues, anger and depression but some serenity about my condition, and striving every day to "get back" and to make a difference in my family's life. I still try to make a difference in everybody's lives. I try to contribute many ways to help other people.

"Relevancy" in my career is different than relevancy see in life. Can I do it all? Time will tell.

Saturday, August 16, 2014

Big Brothers, Sandwiches and Electric Typewriters

My brothers have been a big influence in my life. My brothers are different in some ways but similar in so many ways. I am the youngest of the four brothers, and I learned a lot from them.

When I was in the 8th grade preparing to preregister for 9th grade at O’Leary Junior High, one of my brothers suggested that I should take typing in the 9th grade not the 10th grade which was normal. He took typing in the 10th grade.

He said the typing teacher at Twin Falls High School had some issues with him. It involved a sandwich and electric typewriters. It seems that my brother did not really like typing, the teacher, and perhaps school in general.

The fact that the typing teacher had been teaching since the early 40’s predating electric typewriters was not the issue. It seems that my brother took a bite out of her sandwich when she was not looking and he also sabotaged one of the electric typewriters.

I took his advice and took typing in the 9th grade. I knew my brothers well.

That same fall with I was in the 9th grade, I took Drivers Education. That first day, the teacher said, “Do you have any brothers?”

“Hmmm….” I thought this might be a trick question.  I replied, “Dan?”

He thought about it, and said, “No. I did not know Dan. Any others?”

I responded quickly, “Maybe Steve?”

“I think I remember him, but don’t you have another brother,” he asked?

I sighed, and said, “Dirk.”

“Ah Hah! Dirk! I assume you think you can drive already because of Dirk!”

“Yep!” I said. Honestly, I was proud of him.

He always pushed boundaries, and always wished that I had his courage. Even now. 

I was so glad to take typing in the 9th grade. I could whiz through the typical test typing:  

Now is the time for all good men to come to the aid of their country” in no time flat! 

Not just because of my ill-fated brother’s experience, It turned out to be the best class ever.

Typing prepared me for life. I wrote a regular column in my high school newspaper. After that, in college, word processing changed my life! I was just the fastest typist around. I could pound out articles, reports, op-ed pieces, and detailed, nuanced and thorough research written projects with no problems.

The stroke halted that in one instant. 

I could not even remember what  a letter was let alone the alphabet. The concept of typing was just “gone.” Because of apraxia and aphasia, when my therapist told me that “You HAVE to start writing again,” I said, “I cannot.”

Apraxia (from Greek praxis, an act, work, or deed[1]) is the inability to execute learned purposeful movements,[2] despite having the desire and the physical capacity to perform the movements. Apraxia is an acquired disorder of motor planning, but is not caused by incoordination, sensory loss, or failure to comprehend simple commands (which can be tested by asking the person to recognize the correct movement from a series). It is caused by damage to specific areas of the cerebrum. Apraxia should not be confused with ataxia, a lack of coordination of movements; Aphasia, an inability to produce and/or comprehend language; abulia, the lack of desire to carry out an action; or allochiria, in which patients perceive stimuli to one side of the body as occurring on the other. Developmental coordination disorder (DCD) is the developmental disorder of motor planning.

I have been blogging for years, and after the stroke, it was very hard for me in many ways. Because of Apraxia, when I type the letters “P” and “K” are simply gone.

That old test when I type “Now is the time for all good men to come to the aid of their country” is incredibly difficult.

When I write this blog, I do not look at the keys but I have to “talk” when I write. Here is a test:  When I copy this text “Now is the time for all good men to come to the aid of their country”, this is with I type: “Now is the time for all good men to come to the aid of their countyur.”

Now! This is real time! I just did this now. One mistake! Perhaps I am getting better! 

In honor of my brother, I will have a sandwich and keep typing!

Monday, August 11, 2014

Crying and Strokes

The other day, my wife and I were talking about my stroke recovery. It has been remarkable even though I am not patient.  I want “me” to be back to like I was. That will never happen, but I do agree that I consistently make progress.

My wife commented that when I had my strokes, I cried all of the time.  I was startled. I do remember crying often for a few days. However, when my wife said that I was emotional for months after the strokes, I did not remember that.  

I started to think about my emotions during those awful days and months.

I now realized that I was very emotional. I now remember crying and sobbing a lot. 

One Saturday afternoon when I was in St. Alphonsus Hospital on the rehab floor, I remember sobbing quietly to myself. The nurse asked if she could do anything for me, and I said through my tears, “I really want to be alone.” She closed the door softly, and I cried thinking my life was over.  

Even now, two years and nine months later, I still get too emotional.

When my wife told me about my crying, I started to research stroke and emotional response.

I found a website of the Burlington Chapter of Stroke Recovery Canada. It is very helpful explaining “Emotional and Behavioral Changes After Stroke.” Here is a detailed excerpt that kind of explaining “ME!”

Emotional Factors in Recovery
Following a stroke, the patient's anxiety, fear, and frustration are enormous. Many stroke survivors initially suffer confusion that makes it impossible to do the simplest mental tasks. They often feel helpless and dependent, and their sense of self-worth is diminished. It is important to understand the survivor's limitations and allow an appropriate time for recovery. Self-worth, confidence and enjoyment of life will gradually return.

Encouragement is an extremely important motivating factor for stroke survivors. Caregivers should avoid being critical. While inappropriate behavior should be pointed out, nagging tends to upset and anger stroke survivors, and discourages rather than encourages effort.

Determination is essential in overcoming the effects of a stroke. Patients must be willing to adapt to the disability and be convinced that by therapy they will improve. It has to be stressed that the will to recover does pay off. Nothing helps raise the body and spirit of the survivor of a recent stroke like seeing how their own hard work helps their recovery.

On a survivors return home, the following guidelines will encourage a positive recovery.
  • Set attainable goals the road to recovery is built of simple achievements.
  • Involve the survivor in daily activities and routines.
  • Encourage independent activities, while recognizing the survivor's limitations.
  • Try to maintain social contacts within the family and community.
The Effects of Stroke
Different sides of the brain deal with different areas of human intellectual functioning. Generally speaking, brain damage due to a stroke causes the kinds of problems noted below. However, it is important to note that brain injury in left-handed individuals results in effects that are exactly the opposite of those explained below.

Left Brain Injury (right-sided weakness (hemiplegia)
Those with left brain injury and a paralyzed right side are more likely to have problems with speech and language. Apart from language problems, these individuals tend to be cautious, hesitant, anxious and disorganized when faced with an unfamiliar problem. Many of those with right hemiplegia need frequent assurance that they are doing okay, with lots of immediate positive feedback. Breaking tasks down into steps and practicing often will aid learning.

One-side neglect
Many stroke survivors have visual field defects - up to half their visual field (what they can see with both eyes) is, in simplest terms, not there. This is usually compensated for by turning the head. However, some individuals, usually those with left hemiplegia, have what ranges from a reduced to no sense that their left side exists, or that anything or anybody approaching from that side exists. This is called neglect, and is potentially isolating for these individuals.

Depression resulting from a stroke is one of the most difficult factors for a spouse and family to deal with. A certain amount of crying, though upsetting to the family, may be a natural and normal emotional response to the stroke survivor's greatly changed circumstances. However, chemical changes caused by stroke may result in deeper depression and apathy, with the survivor appearing passive and detached, a state that will usually improve with time.

Emotional Lability
Often, excessive crying seems to have little relationship to sadness or what is happening around the survivor. This loss of emotional control due to brain injury is called emotional lability. Someone who is emotionally labile may not be sad when crying, happy when laughing, or angry when appearing hostile. If possible, interrupting the emotional behavior of such a person (by clapping hands or snapping fingers) is usually a good idea, saving them embarrassment and fatigue.

Change in Personality
Changes in personality and emotional response are common after a stroke. The type, size and location of a stroke, as well as the individual's previous personality all have a bearing on what these changes will be. The stroke survivor may seem a different person, showing feelings of anger, caution or anxiety that are completely out of character. The affected individual may also feel this-and feel less of a person.

Memory Deficits
Almost any brain injury, however slight, may cause memory problems, contributing to language, spatial-perceptual and retention span difficulties. For most stroke survivors, remembering old information (from before the stroke) remains easy, while new learning is difficult.

Some stroke survivors are capable of learning new information, but are unable to apply that learning to other similar situations (generalization). For instance, they may make safe transfers to and from a wheelchair while in the hospital, but are unable to once at home. They may become very sensitive to and often fearful of changes in their environment, and will thus benefit from, and be comforted by, an effectively established routine.

Sensory deprivation and over-stimulation
Many recent stroke survivors are overwhelmed by too much stimulation. When visiting, go singly or in small, quiet groups, and speak one at a time.

Conversely, some stroke survivors may have diminished sensations of touch, pressure, sight or pain, causing them to suffer a constant level of sensory deprivation, leading to psychological stress. The quiet of night may compound this-a radio playing softly or a soft light left on may help.

Quality Control
Even minor brain damage affects a memory related area of behavior called quality control. This refers to how well individuals check and control their own behaviour. A previously fastidious person may fail to bathe or zip his fly, or a formerly polite person may become rude and profane. Caregivers need to be aware of these deficits, and praise appropriate efforts to compensate for them.

The good news, I am still learning about my strokes. The “bad news?” I am still learning about my strokes.

Saturday, August 9, 2014

50 years ago this weekend

50 years ago this weekend when I was 3 years old, my family moved from Montana to Twin Falls, Idaho.  

Our dad opened the new Buttrey Food Store where he was the manager. 

As the baseball player Sam Ewing said,  “When you finally go back to your old hometown, you find it wasn't the old home you missed but your childhood”