dealing with stroke victims

[shrimpchips, LPN]

okay first off, a little bit of background. i'm melissa, i'm 18, and i'm from ohio...i'll be attending the university of akron in akron, ohio as a pre-nursing student this fall. so therefore, i'm not a nurse....yet.

now, story time (if you don't want to read this than just scroll towards the bottom with my questions)

my dad was diagnosed with advanced pancreatic cancer back in march. we would have never known if he never went for his galbladder surgery that day (seeing since pancreatic cancer causes symptoms such as loss of appetite & fatigue that are very common with much less severe illnesses and "ailments") - once the surgeon sliced him open, he discovered a bunch of white spots/patches on the liver. the galbladder wasn't removed so they stitched him back up and told him the news when he woke up. it was certainly devastating to hear that. afterwards, he started chemotherapy. at the beginning of july he had a CAT scan done to see the cancer's progress. the tumor was growing, not shrinking, so the chemo had no effect - but the cancer wasn't evident in other organs or lymph nodes - just the pancreas & the liver. we brought him to a new hospital which has the ireland cancer center. we were originally with the cleveland clinic but his oncologist wasn't say, the most helpful (my mom got the sense that his oncologist was thinking, "this guy is going to die anyway, so what's the point in trying to help him as much as possible?"). at the ireland cancer center they met with my dad's new oncologist, but that day he was in such excruciating pain (because of the cancer) that his oncologist's main concern was getting his pain under control.

he was in the hospital for a week. during his stay he had these little "episodes" - at one point he kept talkin about how he was going to go the baseball game and eat a hot dog. then he wanted to take a shower but the nurse told him he couldn't because of his IV. well, he tore out his IVs and took one anyway - and that is NOT something he would do. when he came home from the hospital, he claimed that he couldn't remember 4 days of his stay there. during his first day home he was in a lot of pain and "just trying to get through the day." the next day he was completely fine. on the third day i came downstairs to find my mom in tears and my dad kept asking, "i need to know where we're going. where are we going? i need to know what we're doing next!" - and my mom would answer him and tell him that we were staying home, and he would answer, "what? why aren't you answering me, annie?" if you tried talking to him, he wouldn't really respond. we called the hospital and at first they told us it might be because of the medication - he was on a lot of stuff and he was probably "heavily medicated" - so they told us to decrease his dosage a little bit. then, he fell asleep for like 3 - 4 hours on the couch and woke up all soaked in sweat. he kept complaining that he was going to pass out. finally we called an ambulance but the ambulance couldn't transport him to the university hospital (which is where the ireland cancer center is) so instead they helped us get him into my mom's car and we drove him to the ER. the nurse triaged him right away and also said it might be because of the medication. she told us, "because pancreatic cancer is very painful, you'll have to make the decision as to whether or not you want him to be confused all of the time or be in pain all of the time." he was brought into a tiny little room in the triage and the doctor came and ordered a CAT scan. this was @ 12:30 in the morning and therefore we had to wait until tomorrow for the news....

...and of course, it wasn't good at all. the CAT scan showed that my dad had not one, but two strokes. he had a minor stroke to his right temporal lobe (which probably explains his episode in the hospital) and then he had a major one to his left temporal lobe - his left temporal lobe was pretty much GONE and the doctor said that there was an almost 100% chance that he wouldn't recover from this and that he'll probably be like this for the rest of his life. all of us were devastated and heartbroken - it really hurts to see him like that; however, he was very fortunate. most stroke victims end up being human vegetables after having a stroke...but he was still able to walk and talk (not clearly...he slurred his speech and spoke in broken sentences...and sometimes he wouldn't respond at all) - he never lost sense of his motor skills.

for the next couple of days he was in the hospital for more pain management and finally he was discharged. the doctor was very helpful and said that he would probably be better off at home, in his own environment.

for a couple of weeks things were good - he was very communicative and he was eating more and more. we were happy about this because it seems like there was some improvement. i know that the brain is a very delicate organ and once parts of his don't recieve blood for a certain amount of the time, the tissue is practically dead. but the human body has it's own miraculous ways of healing itself. anyway, we had family come over to see him and he communicated very well.

but starting about a week ago, he started communicating less and less and he sleeps A LOT. part of it is because of the medication (it knocks him right out) but the nurse also told us it was disease progression - despite the cancer and the stroke he is an otherwise healthy individual. and despite his decrease in communication, he's eating more and more - but he can't put on weight. he's ridiculously thin - i swear he's mostly skin and bones.

he's at a very "aggressive" point at the moment. like when it comes to using the bathroom, sometimes he'll know where the bathroom is and other times he won't at all - one time he peed on the kitchen floor...then he actually made it to the bathroom to peed on the floor and missed the toilet...then he went on the living room floor. my mom caught him undoing his pants and she tried to get him towards the bathroom, but instead he went around into the kitchen (which is the opposite way) and almost went on the floor. then my mom tried to get him to the bathroom, kind of gently grabbing his arm. he got VERY aggressive, yelling and screaming "get off of me" and "ouch, dammit!" and other "colorful phrases and sentences." my mom as really upset, because she can't understand why he gets so aggressive when she was trying to help him. he's really stubborn about these things. the next time he tried going to the bathroom he was about to go again on the living room floor, but my mom caught him just in time with a bucket. he said "god dammit" and was angry but he peed in the bucket anyway...we have a bedside commode but so far he hasn't used it (the past couple of times he actually made it to the bathroom and went IN the toilet, not around it). my question is, does anyone have any idea about dealing with stubborn or aggressive stroke victims? i also had a friend who had an aunt that was diagnosed with cancer, and she also had a stroke...she was very aggressive and did things "out of character" for awhile. the problem with my dad is that when he's mad and you're trying to talk to him, he'll shake his head and roll his eyes and will completely block you out. to talk to him, you sometimes have to get in front of him to get his attention. but when he's angry, he'll just keep looking the other way and won't pay attention.

my other question/concern: along with morphine and other meds, we also have to give my dad lovenox (blood thinner) injections (subcutaneous). as i'm sure all (or at least most) of you know, lovenox injections are to be given in the stomach or in the back of the arm, alternating sides. originally we had to give it to him every 12 hours (twice a day) but now we have to give it to him every 24 hours (once a day). one problem is that it's hard to "alternate sides" because he lays on a couch and it's much easier to reach is right side than his left.

the other concern is that he gets very aggressive with these injections. a nurse told us that the injections hurt, but they don't hurt THAT bad and my dad expresses it as excruciating pain. i can understand that maybe the cancer is making his abdomen tender, but i mean....even if we lift his shirt, WITHOUT EVEN TOUCHING HIM, he'll scream "OUCH!" and glare at my mom and myself. the other problem is because most of the time he's laying flat and not sitting up, there is almost nothing to grab (as i mentioned before he is already ridiculously thin). we poke him with the needle and he'll start moving around with a "THIS REALLY F***ING HURTS!" pain expression his face. he'll scream "OUCH!" and he'll say it multiple times with more meaning, as if we didn't hear him before. other times he has said "OUCH, DAMMIT! or "GOD DAMN YOU!" for giving it to him.

my mom and i are at a state of loss. ANY IDEAS?! both of us don't like giving it to him...i know as a future nurse this will be one of my tasks but it's not giving injections that bothers me, it's giving it to HIM because he's so aggressive about it....

*phew* sorry, that was long. i appreciate those who read this and ANY help would be greatly appreciated.

thank you all so much

[speti4]

I'm sorry your family is going through this difficult time.

What your father is experiencing is not uncommon. As a matter of fact, I recently had a pt with the same moods and he also voided in places other than the toilet.

My recommendation is that your mother speak with his physician regarding these moods and behaviors. There are medications that can help with them. If one doesn't work try another.

Best wishes to you and your family.

[traumaRUs, MSN, APRN]

Melissa - I am so very sorry for what you and your dear father are going through. I can't imagine. However, much as we would like to, we can't provide medical advice. Please talk with your dad's doctor. Take care....