Archive for July, 2011

AIDS DEMENTIA COMPLEX: HIV AND THE CENTRAL NERVOUS SYSTEM-PROBLEMS WITH SELF-CAREA

Friday, July 29th, 2011 | HIV | Comments Off

long with apathy come problems with self-care. Eating, drinking, dressing, and staying clean all come to mean less and less. “Some days I’d come home from work,” said Lisa, “and he’d be sitting in a hot house in the middle of summer with the windows closed, no fan on, and he hadn’t eaten all day, or just ate junk food. Once I made hard-boiled eggs and he made himself an egg-salad sandwich. But usually if I made extra for supper so he could heat it up the next day, he forgot it, or would think cupcakes were easier.”     Eating and drinking are the most immediate problems with self-care, because people with AIDS need to eat good meals. People with dementia lose the internal drive to eat and drink. Lisa complained that she made food for her husband, then asked him if he’d eaten. Her husband would say he had, that it was easy and all he had to do was put the food Lisa left him into the microwave. But in fact, Lisa’s husband did not eat—somehow, he couldn’t think of the steps involved in taking the food out of the refrigerator, putting it into the microwave, taking it back out, and eating it. Or else he didn’t notice he was hungry or didn’t care. Caregivers have to try reminders—to make phone calls or set up routine supper dates. They also need to make eating and drinking as convenient as possible—a dorm-sized refrigerator or a cooler full of juices and snacks by the bed keeps food and drink within easy reach.     Staying clean can also be a problem. “Sometimes my husband was not as clean as he should have been, and would go days without a bath,” Lisa said. “He’d say, ‘I don’t need a bath,’ and would resist any reminding.” Lisa found that the only thing that got him into the bathtub was bribery. “Compliments didn’t work,” she said. “Sweet talk did sometimes. But bribery was the best. He’d need to see some concrete benefit—I’d usually bribe him with bread pudding. I’d say, ‘I’ve got some bread pudding in the kitchen. Why don’t you get a bath, and put on your robe, and we’ll eat that bread pudding?’” Other people are not as resistant to bathing as Lisa’s husband and will respond to “You haven’t had your usual bath. Need any help?”     Making certain the person changes clothes regularly can be accomplished easily: clothes that have been worn can simply be put in the laundry and fresh clothes set out. “Every morning I’d lay his clothes out,” said Lisa, “and every night I’d throw them in the hamper. Otherwise, he wore the same clothes.”     Sometimes, in the later stages of dementia, apathy gets the better of the person in the midst of bathing or dressing. Lisa would put her husband in the shower and he would not bother to come out. Or she’d help him with one sleeve of a shirt, and he would not put his arm in the other sleeve. Sometimes people seem to lose their sense of modesty and don’t dress appropriately. At these stages, the caregiver needs to be around fairly constantly, and to remind or help the person to finish up the process that was started.*148\191\2*

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: SPASTIC QUADRIPARESIS AND DIPLEGIA

Spastic Quadriparesis Children with stiffness in all four limbs (spastic quadraparesis) usually have sustained severe damage to the entire brain. They are likely to have severe or even profound retardation. They often have experienced seizures in the newborn period (see neonatal seizures) and may have had infantile spasms during the first year of life. They will have a high incidence of generalized tonic-clonic seizures as well as of atonic attacks and the Lennox-Gastaut syndrome. Seizures in children with spastic quadraparesis may be very difficult to control.DiplegiaDiplegia is the type of cerebral palsy in which both legs are stiff. It is far more common in children who were born prematurely than children carried to full term. These children are usually of normal intelligence and are less likely to develop seizures. Their principal handicap is a difficulty with walking; physical therapy, bracing, and orthopedic surgery can often be of help.*200\208\8*

ADOLESCENT ALCOHOLISM TREATMENT: ALCOHOL/DRUG ASSESSMENT

Once the issue of confidentiality has been cleared up, it is important to take a family history. Ask about alcohol or drug problems, prescription or nonprescription. Include the grandparents, uncles, aunts, brothers and sisters, and cousins, as well as the parents. Other important parts of the history include asking the adolescent how he spends his time. Ask him to describe a typical day. Ask what he and his friends do Saturday night. Ask about his peer group, about their age, activities, drug and alcohol use. Ask how they are seen and described by other groups in the high school, and then ask about his own use of drugs and alcohol. Ask about parental relationships. Ask about sleep, appetite, depression.The fact that adolescent alcohol abuse can go on for as long as 6 years without being diagnosed is a tribute to the ability of these adolescents to hide their problems, to the ability of parents to avoid recognizing problems in their children, and to the ability of school systems to ignore or expel problem children. It is not unusual for parents to be actively protecting, rescuing, and taking care of a substance-abusing adolescent without realizing that this supports and prolongs the abuse. They make good on forged checks. They hire lawyers or pay to have legal charges dropped. They go to bat for them at school or blame school authorities for the problems. In our experience, parents must stop protecting these children and seek help for them instead.When asking about drug and alcohol use begin by asking about the first time he or she was drunk, how much they drink now, how often, if they have ever tried to stop or cut down. Ask about blackouts, legal problems, and school problems. Finally, don’t assume that an adolescent is providing a wholly accurate history about drug and alcohol use. Denial is a central characteristic of adolescent alcohol or drug abuse. It is important to get information from parents and teachers whenever you are concerned about adolescent alcohol or drug problems.*151\331\2*