Transient Ischemic Attacks--need practical advice

  1. Hi--my 87 year old Dad takes great care of himself (good diet, walks a mile a day, stays happy and involved, exercises his mind). He has been experiencing what have been described to me (third hand, so who knows) as TIA's. I haven't been with him when he has had an "attack." Yesterday in the doctor's office was the most recent one. They MRI'd him right away, I don't know what the results were, if there are any yet. They did let him drive home (:angryfire what if there had been an accident???). My husband said his fine motor was such that he had great difficulty getting his eggs on his fork at lunch an hour or so later.

    Basically, he loses his balance. The problem seems to be focused in motor and maybe balance, but we think the balance problem might be because of the motor issues. One time the EMS was called and his BG was around 45, they gave him some sugar PO and it was around 150 in the ER. This was the worst one, and there did seem to be some short-lived cognitive issues (wasn't sure where he was at the time, and this was a place he goes with his friends almost weekly). He later said some of the the cognitive problems hung on "for a while" (he said he recognized that he wasn't thinking as clearly as he is accustomed to--he is an engineer and critical thinking is a big deal).

    He also has some vertigo at times for which he takes diphenhydramine po prn. He takes some HTN meds, aspirin, not sure what else. He has no chronic problems (other than this, and this doesn't slow him down much), is thin, has a good appetite and as far as I know, all systems are go. Coordination is fine, except for when he has these.

    I am looking for suggestions as to what we should be watching for or doing, to minimize the frequency, intensity and duration of these events. We recognize that at 87, these kinds of things start to happen to the best of us.

    Any suggestions? Ideas?

    Thanks
    Last edit by chris_at_lucas on Jul 1, '04
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  2. 12 Comments

  3. by   Destinystar
    i am sorry but it is out of a nurses scope of practice to be offering medical advice and to be making a medical diagnoses. sounds like your dad needs to go to an md he can trust and follow up on any referrals. these are questions with your dads permission that you would want to ask his md or any other health care provider that has first hand information about his condition. it is also a violation of his privacy to post information about his medical problems without his permission (hippa).
    Quote from chris_at_lucas
    hi--my 87 year old dad takes great care of himself (good diet, walks a mile a day, stays happy and involved, exercises his mind). he has been experiencing what have been described to me (third hand, so who knows) as tia's. i haven't been with him when he has had an "attack." yesterday in the doctor's office was the most recent one. they mri'd him right away, i don't know what the results were, if there are any yet. they did let him drive home (:angryfire what if there had been an accident???). my husband said his fine motor was such that he had great difficulty getting his eggs on his fork at lunch an hour or so later.

    basically, he loses his balance. the problem seems to be focused in motor and maybe balance, but we think the balance problem might be because of the motor issues. one time the ems was called and his bg was around 45, they gave him some sugar po and it was around 150 in the er. this was the worst one, and there did seem to be some short-lived cognitive issues (wasn't sure where he was at the time, and this was a place he goes with his friends almost weekly). he later said some of the the cognitive problems hung on "for a while" (he said he recognized that he wasn't thinking as clearly as he is accustomed to--he is an engineer and critical thinking is a big deal).

    he also has some vertigo at times for which he takes diphenhydramine po prn. he takes some htn meds, aspirin, not sure what else. he has no chronic problems (other than this, and this doesn't slow him down much), is thin, has a good appetite and as far as i know, all systems are go. coordination is fine, except for when he has these.

    i am looking for suggestions as to what we should be watching for or doing, to minimize the frequency, intensity and duration of these events. we recognize that at 87, these kinds of things start to happen to the best of us.

    any suggestions? ideas?

    thanks
  4. by   chris_at_lucas_RN
    I see you are a new member. Welcome to allnurses.com. I've certainly made errors, here and elsewhere, although this is not one of them. You, my dear, are wrong.

    We share lots of ideas here, not the least of which is clinical information. Look around, read a few posts, you'll see what I mean. There is a lot posted about specific patients--their clinical info, no identifying info, of course. Nurses supporting nurses, that's what this is about.

    I know for a fact I am not out of line. Who are you to tell me that I am? You are not even right about the HIPPA issue. It does not apply to family members.

    Even so, this is an anonymous BB--and I have not revealed my Dad's identity, and I am not his nurse, so I haven't violated any rules, HIPPA or otherwise.

    Obviously he has a doc, he was there yesterday when he had his TIA. I am looking for nursing info of an educational nature for us, his caring family.

    Thanks so much for your comments though. (NOT.) ( :stone )

    Now, do you have anything that can help me? (If not, please don't bother responding to this thread--it takes up space and makes me think there is something of value for me when I got the notice in my email box.)
  5. by   CoffeeRTC
    Sounds a little like my Gramm. She's a little older and has had multiple TIAs. Unfortulalty she doesn't live alone anymore She is still in her own house tho. We take turns spending time with her. Basically no more strenuous stuff...(trimming hedges, vacuming etc)
  6. by   jayne109
    I work on a Neuro floor and I have a few questions:

    Have they done and Ultrasound or an MRA on his Carotid arteries?
    Does he get any other problems ( i.e. weaknessin one hand, slurred speech, mouth droop)?

    Have they drawn a Homocysteine level on him lately?

    The homocysteine level, I learned, affects the clotting factors in his blood (or something like that) .

    I also have a couple of textbooks that have really helped me with the Neuro stuff. Let me know If I can help you.
  7. by   Repat
    Also, check into how often he takes the prn Benadryl. If he 'forgets' and takes too much it can make him dizzy and impair his cognitive functions.
  8. by   rjflyn
    Take his car keys. He probably should not be driving, in fact the doctor shouldnt have let him drive home- if he would have had an accicent the doctor would have be liable. That said and an MRI being done, the next step is to wait for the results. He probably should see a neurologist if this is a continuing problem.

    Rj
  9. by   leslie :-D
    hey chris,

    generally speaking (i want to say all the time) tia's are unpreventable and NO, he should not be driving. the biggest concern with tia's is that they often lead to a major stroke. but you said he takes his bp pills, asa...you might want to have a lipid profile done. the only other thing is that diphenhydramine is contraindicated in the elderly and could be exacerbating certain conditions. many mds don't even know this unless their specialty is geriatrics. perhaps your dad should consult with a geriatric specialist. best wishes.

    leslie
  10. by   redshiloh
    They probably let him drive because they had not made a definitive diagnosis.
    Does he live alone?
    TIAs symptoms generally resolve after a period of time, are they?
  11. by   leslie :-D
    Quote from redshiloh
    They probably let him drive because they had not made a definitive diagnosis.
    Does he live alone?
    TIAs symptoms generally resolve after a period of time, are they?
    yes they do but people/pts are quite 'spacey' for a long time after.....
  12. by   chris_at_lucas_RN
    I've been reading...

    TIA's by definition resolve within 24 hours. His usually resolve within an hour or two. They are recurring and are a source of concern to us.

    He's a sweetie and puts up with (actually invites) our caring for him, so I will as about the homocysteine and other levels, as well as what the MRI result was. (He is especially proud of me and my recent nursing successes--I should say this Dad is my second one, not the one I may have referred to in other posts, who died about 20 years ago.)

    Consequently, I can get away with more nosiness than the other sibs.

    Don't know about carotid ultrasounds, but one of my initial thoughts was whether he might have some clogged up carotids. I saw that TIA's can be caused by little emboli.....

    His doc is an internist who he has had for about 10 years and whom he trusts. I'll have to ask him if the guy's waiting room tends to have older people in it (might be a clue anyway).

    No mouth droop, no slurred speech, no unilateral weakness that I know of--I will ask about this.

    I was wrong, he doesn't take diphenhydramine (I'm still spacey from that CPNE, apparently), he takes meclizine prn for vertigo.

    I'm planning on having a little chat with him about not driving. He usually doesn't, as my sister-in-law goes out to dinner a lot with him and she picks him up. He does drive himself to the doc, though.

    He lives alone in a very close neighborhood, and checks in on (and is checked in on by) several neighbors and a couple of fellow "geezers" by phone. Plus, his walking (in decent weather) is with the young family next door.

    Okay, I think that covers the bases. I cannot thank you all enough--and of course I am not through depending on you! I feel cozily supported. I'll let you know what I find out about the labs, etc.
  13. by   Havin' A Party!
    A few additional thoughts. He may wanna consider keeping himself well hydrated, and supplementing with E and C. Also eating oily fish, at least, once a week and garlic.

    The HTN meds, exercise and aspirin sound right on.

    (P.S. -- All the usual disclaimers apply. )
  14. by   leslie :-D
    chris,

    with tia's, any unilateral weakness, drooping, slurred/no speech would be temporary. and if you look into carotid blockage, just be careful as there are a unique set of risks of elderly having surgery....

    and elderly are almost always committed to their docs that they've been seeing for years. us nurses might think these md's are for the birds, but it's useless trying to convey that to our patients.

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