And so the verbal reports are much exaggerated, and assessment by yourself is always better. On the bus back to Kuantan (I left my laptop charger at home, yikes!)..
A 50 year old man, a known case of DM for 20 years, migraine, AAA, ureteric stones (I know it's irrelevant) and recent history of CVA (with no disability prior to the new admission) presented with reduced ability to speak and right upper limb weakness. CT brain at the A&E did not reveal any abnormalities. The patient was advised for rest in bed in the ward. On day 4 of admission the patient suddenly deteriorated, with Broca's aphasia (inability to speak but understands input) and right hemiplegia. Urgent CT scan revealed slight hypodensity at the left frontoparietal region. Subsequent MRI revealed a watershed infarct at the left frontoparietal region. CT with contrast revealed contrast flowing into most areas except for the hypodense area mentioned earlier. A subsequent CTA revealed a complete thrombosis of the left ICA just distal to the bifurcation of internal-external carotid arteries. The right ICA is atherosclerotic but not stenosed. The circle of Willis was normal, and evidence of flow from the right cerebral circulation to the left side was present. Previous lacunar infarcts were present but not enlarged.
This was with a picture of atherosclerotic right and left ICA via MRA 2 months earlier.
2. The good news is that Abah actually survived the incident. Had the thrombosis occurred much more acutely (and hence without the good collateral flow) death was certain. At the time of typing he is surviving with blood flow to the brain coming from the left ICA and vertebral vessels only. The right ICA is certainly pounding in character. I'ved told my mother to not allow the artery to be occluded, ever. The bad news is the current disabilities: he can mention few words when "forced" (Sarah, Allah). His improved power is 2-3/5 for the lower limbs, 2-4/5 (depending on motivation/desperation) for the shoulder-elbows, 2-3/5 for the fingers, 1/5 (twitching is at least there) for the wrist. He has improved quickly due to the intense therapy. A lot of the bad news I heard earlier about him were related to psychomotor retardation from frustration, and just not wearing glasses (so he can't recognize stuff better). Otherwise he is much much better than how I feared. What Abe and I said to myself (I don't really listen to myself) was true: do the assessment yourself first.
3. Since rehab is a lot about neuroplascity, Abah needs a lot of motivation to keep on trying. He seems to resist Umi's efforts to get him to move, and hence that's where I come in. With me there, we've forced him to stand with a walking stick, keep on moving the upper limbs, walk albeit slowly, and speak. Due to him lying around, he's been getting multiple episodes of reperfusion pain (think folding your legs for a long time, then getting the pins and needles when you stand up), so I'ved taught him to sit and hang his legs first, letting the pain go away, then stand. I've also told him to keep the legs moving (and have others help the right leg) to keep the blood flowing and prevent reperfusion in the first place. From no power, to at least walking-shuffling with help in a week: pretty good. Talking will need more motivation and mental focus, so...
I've given him homework while I'm gone: walk 5 times a day, start every upper limb activity with trying to use the right arm first (mimicking retstraint-induced therapy), speak 1 new word a day, breathing exercises, and reading the paper. He doesn't like it, but it's for him. I'm a sadist. The only problem is that there's no time for him, as he's so popular and liked by friends, family and students, so the room's almost always full.
4. Those who know me well know that's how I treat myself and teach others: I'm very mean. And the simple reason is that the human body and mind is a fucking amazing thing. The ability for learning, readaptation and compensation is pretty good. Hence why many hate it when they ask me for help/coaching: ask Coax how it feels like to be doing pushups to failure to rehab the shoulder, Abe when slacking off on doing those squats with a light load, or juniors when asking me q's (I ask them back to lead to the answer). But it works pretty good, as it teaches the man to fish and overcome his own mental barriers to success.
5. Behind the seriousness of the situation, there was some humor. I'm bad with diplomacy, and it required Umi's diplomacy to allow us access to the reports and scans. I told Umi that Abah is a good candidate for at least a short case (with laughter from the staff nurses as well). And I managed to teach Faiz probably 30% of all he needs to learn about radiology. Even in a situation where Abah is ill I can see him with "medical" glasses. But that's just how I am.
But that's the nature of medicine: what is bad/painful for the patient is amazing for the student.
6. I'm getting fatter (can't train as often, and diet is not adapting to it), although my weight remained the same; there must be some lean mass loss as well. So I compensated with my lack of conditioning (I focused on strength) by walking up the stairs to the ward, at level 7. I even ran up the stairs this morning. 4 rounds in all, I'll do it again next week. But not at HTAA; the staff ward at UKM is air-conditioned.
7. Thanks for all who came by to visit, especially family members who kept pressuring him to keep trying to move. Some think of it as military motivation. Think of it as doing what's best for the patient.
Training:
My wrist feels good, but no heavy rowing is possible still. I've been pushing the work, as heavy training beats the stress way. This is despite combining 4 training days into just 2.
Good mornings - up to 63 kg x 14(?)
Standing DB presses - up to 35 lb x 16
Back squats - up to 67 kg x 14 (?) (I'm damn demented)
Weighted pushups - up to BW + 20 kg plate x 13
Seated cable rows - up to 100 lb (full stack) x 5 x 8 (these were brutal by focusing on not using my torso to compensate)
Penlay rows - these were uncomfortable when with 100 lb at reps 6 and more. I might focus on keeping it less than 5 reps.
I'll try the heavier deadlift, BP, MP work next week and test out further my wrist.
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