A: Confirmation of a Mild Stroke
Last month our doctor informed us that my wife may have had a mini stroke just recently that we were not aware of. We thought that her symptoms of weakening in her legs and a slight stutter and a slight loss of memory was due to her Parkinson Disease diagnoses about 6 months ago. Our neurologist ordered an ultrasound of her neck first (#1 test). The results showed plaque formation on her right carotid artery. So my wife has indeed carotid artery disease. However, the extent of the blockage is not clearly shown by the ultrasound. So three other instrumental diagnostic tests were ordered besides the first test to confirm and show how extensive is the blockage. The following test were done to my wife during the last four weeks.
1.Medical sonography (ultrasonography) is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images. Ultrasound has been used by radiologists and sonographers to image the human body for at least 50 years and has become a widely used diagnostic tool. The technology is relatively inexpensive and portable, especially when compared with other techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT)
2.CT scanning of the head is typically used to detect infarction, tumors, calcifications, haemorrhage and bone trauma. Of the above, hypodense (dark) structures can indicate edema and infarction, hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows. Tumors can be detected by the swelling and anatomical distortion they cause, or by surrounding edema.
3.Magnetic resonance angiography (MRA) generates pictures of the arteries to evaluate them for stenosis (abnormal narrowing) or aneurysms (vessel wall dilatations, at risk of rupture). MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (called a "run-off").
4.Echocardiogram, often referred to cardiac echo or simply an echo is a sonogram of the heart. (It is not abbreviated as ECG, which in medicine usually refers to an electrocardiogram.) Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart. Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology. It can provide a wealth of helpful information, including the size and shape of the heart (internal chamber quantification), pumping capacity, and the location and extent of any tissue damage. .
The above four test are all non-invasive tests. There is another test slightly invasive that will confirm the extent of the blockage as follows:
Cerebral angiography (carotid angiogram). This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications.
As of this writing date, we have not decided what surgical or medical treatment will be done. We have an appointment to see a vascular surgeon next week. Please pray for my wife's health. The following three web sites are excellent references if you need additional and detailed information on carotid artery disease.
References:
http://www.webmd.com/heart-disease/carotid-artery-disease-causes-symptoms-tests-and-treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665982/
http://www.mayoclinic.com/health/carotid-artery-disease/DS01030/DSECTION=treatments-and-drugs
Note: Last December 2013. my wife had carotid endarectomy surgery. She is doing well after surgery. Her final check to verify if the plaque on her carotid had not recur will be next month. I am hoping for the best.
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B.Tribulations and Pains of a Primary Care Giver
Last year my wife of 57 years was diagnosed with Parkinson’s disease. She is taking two medications that control her tremors. However, the two medications had several side effects such as constipation, nausea, itching, hypersensitive to sound and minor events in her daily living.
Her constipation and itching are alleviated by drugs and diet. Nausea is prevented by herbal drugs as ginger tea. However her hypersensitivity to sound and excessive concern for minor events in her life often frustrates me. I have to be patient and kept my cool most of the time. However today here in Amoingon, an event occurred that made me raised my voice in frustrations. But before I discussed this event , let me described our life here in Marinduque versus our daily life in Northern California, USA.
In the US I am the primary care giver with some minor help from my youngest son who also live with us. My son works full time and he can only help during his days off. My wife needs constant attention to prevent fatal falls because of her unbalanced gait, and walk. Last year she fell five times. Luckily her falls were not serious and I was there to help her.
Here in Marinduque we hired two temporary help until the first week of May-our scheduled return to the US. This is a much needed relief of my duties as the primary care giver. However at night I am always ready to assist her going to the bathroom and her other personal needs when our live-in help is asleep in the next bedroom.
The other day an incident occurred that made my wife very upset with concern. One of the gardeners doing yard work cut his hand while cutting a young coconut to drink the coco water. We immediately washed it with water and alcohol and applied bandage to the wound. The next day he did not report for work and my wife was so concern for the welfare of our gardener. She wanted me to drive him to the local hospital for a tetanus injection right away while we are still having breakfast. I told her to wait for our driver who was doing some errands and let him drive the gardener to the hospital for his injections.
I told my wife today I am waiting for a call from the US regarding the prospect of renting the beach house for Holy Week this year thus I can not leave the house. She murmured that I am more concern of the call from the US than saving the life of our gardener from a tetanus infection. When I heard this I blow my cool and raised my voice in frustration. I felt MY BLOOD PRESSURE went up. I have to go to my computer for relief and to calm down from my anger and frustration. Again, thank you DSL and my Internet Connection!
Again, Please Lord let me maintain my cool at all times especially when irrational behavior occurs with your love ones that is suffering from neurological disorder such as PD and AZD.
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