Home Alone!

Elderly_Home_Alone
When Elderly are Home Alone!!

Mr. S a quintessential gentleman of 92 summers lives alone in Chennai. After an illustrious career in the Indian Army, having occupied high positions and served actively in 3 wars, he retired to a salubrious lovingly constructed home, over 3 decades ago. Over time his home has emptied itself of his loved ones: first the children and their families migrating to live and work abroad, then the sad passing of his beloved spouse. Yet Mr. S has soldiered on- visits to his local club to play Tennis and Bridge, daily walks in the neighbourhood park, his favourite newspaper read with diligence and attention, periodic socialising with friends. Annual visits to the US where he would spend the better months of the year with the family. The ravages of time have however taken their toll. The onset of dementia about 5 years earlier, gradually made it impossible for him to continue his routine. Most of his friends have either passed on or are too immobile for him to meet frequently. The children and grandchildren visit, often taking turns, striving to attend to his every comfort. He does, however, find it increasingly difficult to place them, and to have meaningful interactions. The sad reality is that this proud soldier is in the winter of his life, home alone!

Mrs. M of 87 summers is home alone too. Widowed over a decade earlier, this mother of two successful NRI male professionals has lived alone in her Chennai apartment all this time. Her successful sons who are both in the 60’s and have made their lives and careers abroad. Spirited and sagely, she lived an independent life, commuting in autos, managing her own financial affairs, travelling abroad periodically to spend time with her children, grandchildren and recently great-grandchildren. All this came to a halt however, a few months earlier, when she was struck down by two successive neurological conditions: a stroke that affected her mobility, from which she recovered, and inflammatory neuropathy that conferred fresh disability. Yet she has shown determination to survive these setbacks, to stand up and walk again. Her children and their families have tried to visit, to spend time, to attend to her every need. But in their absence, which sadly is much of the time, the care has been provided by a loyal team of caregivers, lead by our TRIMED home care doctor and home therapy team.

Like many elders both Mr. S and Mrs. M have had several ups and downs in the months/ years that we have been privileged to care for them. It’s not just the periodic health check or blood test. The many mini crisis- episodes of breathlessness precipitated by a change in weather, sometimes by an evolving pneumonia or reactivation of asthma; falls in the bathroom, sometimes with just soft tissue injury needing an ice pack, on other occasions a fracture needing hospital intervention; urinary tract infections on occasion leaving the person confused and disoriented; the care of the home alone elder is a veritable roller coaster ride. Yet, through regular medical visits, sessions of acupressure and reflexology, Physiotherapy, cognitive retraining and supportive counselling, therapeutic massages- both Ayurvedic and Naturopathic, our team has kept these elders in good spirits, pain free, able to cope with the ravages of time and chronic disease. TRIMED’s home care thus comes with a difference; not just doctor visits or lab tests, but care that uplifts the individual, rehabilitates them, improving life quality and activities of daily living, supports the caregiver, providing help in times of crisis and succour always.

That PICA (parents in India, children abroad) syndrome is a horrific emerging reality in urban India, came to the fore last week for us. Mrs. M became acutely ill, early one morning. From arranging an ambulance for immediate hospital transport, to rushing over to assist at 5.30 AM, the TRIMED team acquitted itself remarkably well. In the end we lost the grand old lady to the inevitable icy cold hands of death; a peaceful passing with as much comfort as we could muster. Until her family living abroad could come and take charge, TRIMED was in action- participating in making arrangements for the freezer box, funereal, even the priest! We feel greatly privileged to have served Mrs. M in this way. In the end, while circumstances left her “Home Alone”, she found TRIMED and therein a caring team of professionals, willing to go the extra mile.

Frozen Music

BMMrs. P, a carnatic music teacher was admitted in an esteemed hospital based in Chennai with complaints of pricking and pulling pain in the right shoulder, difficulty in lifting her arms and gripping objects. This led to inability in doing her activities of daily living such as grooming as well as her household chores. She was a diabetic on regular treatment with suboptimal control of her sugar levels. Adding to her existing woes, she had an unsteady gait resulting in multiple falls and a sudden cessation of her music classes leading to extreme health related anxiety.

After discharge from the hospital, she underwent a comprehensive integrative clinical assessment by our team, which revealed a history of longstanding right shoulder pain which forced her to use her left hand for all her activities – quite an arduous task for someone who is not ambidextrous. The pain was persistent in spite of a course of physical therapy.

At Trimed, based on the detailed assessment, she underwent a comprehensive integrative program for peri arthritis of the shoulder for a month. This included a combination of Ayurveda, Reflexology, Mud Pack, Physiotherapy and Psychological counseling from our team of specialists. Ayurveda therapies comprised of medicated hot foments, gentle oil massages, and Physiotherapy included Electrotherapy, manual therapy, muscle strengthening with exercises – both the modalities helped in the pain reduction and loosening of stiff muscles. Reflexology helped improve blood circulation and re-activation of the nerve centres. Mud Pack helped in proper digestion and improvement of appetite. She underwent psychological counseling and was taught the Jacobson’s Progressive Muscle Relaxation technique which was effective in reducing her anxiety. Breathing exercises and Meditation along with carnatic music was also engaged as a part of anxiety and pain relief treatment.

The caregiver was educated with the ways and means to help her in recovery as a part of family counseling. The extensive support from her family played a major role in her speedy recovery.

At the end of the treatment program, mobility and flexibility was restored to her right shoulder and she was able to use it as well as before. She was back to juggling the various tasks she took pride in doing, with a flourish.

Her feedback about Trimed was that she loved coming for treatment because of the friendly demeanour and efficient service of our team. She also continued with a regular exercise regimen at home which was taught to her at Trimed.

Her words of gratitude to Trimed poured forth in the form of enchanting music, enthusing our team with a sense of pride and satisfaction about restoring an optimal quality of life for yet another patient in the true blue Trimed Way.

This TRIMED story is contributed by Ms. Angeline Vinitha, our Specialist in Psychological Counseling.

When God Closes One Door…

hopeNothing strikes greater fear in our hearts, than the possibility of lifelong disability. Sadly, modern medicine’s many advances, are yet to guarantee complete recovery from paralytic strokes, with the sceptre of lifelong disability looming large for stroke survivors.

Mrs L , an 80 year old housewife, was taken to one of Chennai’s major hospitals, after she suffered a brain haemorrhage. The event had rendered her unconscious, paralysed on the left side, unable to speak and swallow. Doctors in the hospital had done a wonderful job of saving her life- using a ventilator, tracheostomy and Ryle’s tube to allow her to breathe and receive fair nutrition. Three weeks on, when she was transferred to our care in a partner hospital, Mrs. L was barely conscious; had a tracheostomy tube, feeding tube and catheter in place, was severely paralysed on the left side (not even a flicker of muscle contraction), had excessive throat secretions and severe chest congestion.

After the TriMed comprehensive 360* assessment overseen by our neurologist and rehabilitation physician, supported by our chest and ENT physician, we optimised all her medication including broad spectrum antibiotics and nebulisation, and introduced moderate dose intravenous steroids to kickstart brain function. We also started to deliver to her, on her bedside, an integrative therapy program, including twice daily sessions of physiotherapy in the form of passive and active exercises and Naturotherapy interventions such as acupressure, acupuncture and reflexology. We started work with her family, helping them cope with her condition and setting graded realistic goals. Over two weeks Mrs. L responded well to our treatment approach; her consciousness and comprehension improved, and she began to respond and obey simple commands. We were able to make her sit with support, with which her chest secretions reduced. She regained urinary sensation and gradually her catheter was removed. She started to show response in the paralysed limbs, first flickers of contraction, later movements with gravity eliminated and then against gravity, finally against resistance. She stood with support, even walked a few steps. However, there was persistent left vocal cord palsy and a trial of tracheostomy removal failed. For this reason we also had to leave the feeding tube in place.

She was discharged to home care with a nursing partner team, and continued to undergo integrative therapy. Sessions of Ayurveda therapy in the form of oil massages and medicated foments were now introduced to improve limb power and movement along with continued physiotherapy and naturo-therapy. The psychological therapist engaged her in cognitive therapy and motivational enhancement, apart from helping her caregivers deal with their distress. Over 6 weeks, she began to walk with support , express herself with gestures and swallow small amounts of soft solids. Apart from a minor bout of aspiration pneumonia in the interim, requiring brief hospitalisation, she made good progress.

Mrs. L was back in hospital for a team review last week. During this visit her tracheostomy tube was removed, and she regained her ability to speak, albeit hoarsely. Her chest is clear and she is progressively able to swallow more each day. Her gait has improved and she walks with support. She is on course to having the feeding tube removed. She appears bright, sprightly and ready to engage with the world. Her children and grandchildren are delighted to have their beloved grandmother back, now that the TRIMED Way has rehabilitated her and restored to her, a reasonable quality of life. What is truly remarkable is that 3 months after the onset of a paralytic stroke with severe neurological deficit, this lady of 80 summers has planned and presided over her family’s Pongal (harvest festival) celebrations, with zest and happiness.

She found TRIMED’s integrated approach and in her we found the steely determination needed to conquer the sceptre of lifelong disability. Truly, when god closes one door, another does open!

A Himalayan Odessey

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Mr. V a 62 year old male, was brought in to Neurokrish-Trimed as he had been having difficulties with walking, could not perceive depth, experienced poor memory, and had become withdrawn, fearful and depressed. He fell from a height while on a pilgrimage in the Himalayan range in 2010, became unconscious, reached civilization after a week, was in the ICU in a local hospital for some days, before being brought to a major Chennai hospital for  treatment, following which he made a slow recovery. This, however, hit a plateau in mid 2012 at which time he showed signs of depression. He was diagnosed as having hypertension after the fall and had developed issues with hearing in the right ear. An entrepreneur, perfectionist and workaholic, he was religious and had enjoyed reading and travel (prior to the accident). When we met him in 2013, he was concerned about disabilities and his business which had wound down during his illness.

Mr. V underwent our 360* True Health assessment which demonstrated physical (especially walking, frequent falls and an inability to climb stairs); cognitive (working memory, planning and sequencing activity, visual spatial skills, motor tasks, short and long term memory); emotional (low mood, anxiety, feelings of hopelessness and worthlessness) and behavioural (irritability, low frustration tolerance, impatience and poor interpersonal skills). In addition he had issues with his bowel, bladder and sleep. He was enrolled into our comprehensive rehabilitation program for people with multiple medical disabilities. This included Ayurveda treatments; physiotherapy including gait training; psychological counselling including cognitive retraining, cognitive behaviour therapy (CBT) and caregiver counselling; mud therapy for bowel and bladder disturbances; acupuncture; and other supportive treatments. His drug treatment was optimised with new drugs added to the regimen, redundant ones tapered off, and aided by therapy the number and frequency of drugs taken by him, steadily brought down.

Over a few weeks Mr. V has made a steady recovery. His cognitive difficulties have largely remitted, his walking has improved, so much so, that he now does 5 kms on his own and walks his dog as well; his mood has improved, anxiety reduced and confidence levels have been boosted up considerably; he is attending to his business again and has started to strike new deals, possibly saving his factory from closure; he is even planning a visit to the USA to spend time with his daughter, rekindling too an old desire for travel. Mr. V continues to attend his medical reviews and booster therapy sessions regularly as scheduled and is gregarious in his interactions with the treating team, often sharing a hearty laugh. His family are besides themselves with joy to have him well and truly back in their midst, for his has truly been “A Himalayan Odessey”.  For us at Trimed Mr. V and scores of courageous patients like him, are our true inspiration.

The Pursuit of Wellness

PC: UND
credit: UND

When Mr. R the CEO of a very large enterprise first walked into TRIMED it was for non-specific aches and fatigue, no doubt the result of his highly pressured lifestyle. After a course of treatment, while he reported an improvement in his general well-being, he also shared with us his valuable impressions and insights, about how our therapeutic process could improve to address “relatively well” clients like him-self. Indeed, his frank feedback resulted in our implementing no fewer than 3 key therapeutic process developments in TRIMED. When Mr. R contacted us a few months later, seeking an urgent consultation on Sunday, it was with a whole new set of complaints. He had developed severe and unpredictable giddiness of three weeks duration, which had incapacitated him to such an extent that he had stopped working for over 10 days. Predictably Mr. R had seen specialists of every description: ENT, orthopedics, neurology, all of whom had cleared him after extensive investigations of having a serious problem, leading (much to his dismay) to his family doctor suggesting he see a psychiatrist for mental stress. Fed up with his many medical interactions, Mr. R decided to come back to TRIMED, this time with “significant’ medical symptoms; not merely for wellness, but seeking a cure.

When we re-examined Mr. R we noted three key factors.
a. Cervical spondylosis and resultant severe cervical spasm
b. Postural vertigo that came on suddenly when he moved or changed posture
c. Accompanying acute anxiety and phobia about falling that understandably accompanied the aforementioned symptoms.

Mr. R was started on a TRIMED program to address the aforementioned key factors. A combination of massage, physiotherapy (posture and balance exercises and instrumental therapy to reduce cervical spasm) and Relaxation techniques were delivered sequentially to him in our TRIMED center over 2 weeks. He did of course receive suitable allopathic medication for these new symptoms.

In a week Mr. R was feeling much better, started to travel to his office and spend a couple of hours there, bringing work home. In two weeks he stopped experiencing his giddiness episodes and was well enough for prolonged periods of time, to return to measured daily duties. A month on, he was back in his CEO saddle, multitasking, travelling extensively, managing crises in multifarious forms. Two things have changed however: Mr. R has become more measured in his approach to his work life balance. He is also regular with his practice of the TRIMED Way. Mr. R still drops into TRIMED religiously for an hour long weekly session with his favorite therapist; his way of “staying well”. Mr. R found TRIMED and together with us has made the journey from Illness to Wellness, like so many others before and after him.

The Real Mrs. B

by istockphoto.com
by istockphoto.com

Mrs. B, the wife of a Nellore based farmer, came to see us in Trimed a month ago, referred by one of our very satisfied clients. She had an episode of Herpes Simplex Encephalitis a serious brain infection about 4 months earlier. While treatment in a major hospital had saved her life and helped her go home, she had been left with a host of memory and behaviour problems. The normally placid and convivial Mrs. B had become aggressive, paranoid, forgetful and dependant on others for all her daily activities. So much so that she was no longer Mrs. B- the loveable person everyone knew. Her family were beside themselves with grief to see the the nucleus of their household so devastated by a brain infection.

Mrs. B was admitted in our partner hospital under our care, evaluated by the Neurokrish-TRIMED team (our 360* True Health assessment), administered intravenous steroids to spur on her brain recovery, prescribed an optimum range of psychotropic drugs and inducted into our TRIMED therapy program. In this week of hospital based therapy, we made several clinical gains- better behaviour and orientation, better cooperation with the therapy team and her family, better nutrition and improved activities of daily living. She was discharged to our centre where she continued to receive physiotherapy, mud therapy, acupuncture, Jacobson’s Progressive Muscle Relaxation exercises and expert Cognitive Retraining and Cognitive Behaviour Therapy. Her family was also counselled about her condition and how to care for her.

Today, Mrs. B is wending her way back to Nellore from Chennai, a transformed person. Once again she has become placid and calm in her responses. She trusts her family members and interacts with them normally, not displaying any temper tantrums. Her memory is improving with each passing day and she no longer has the profound lapses she was experiencing even a month ago. Mrs. B is a very good example of how brain infections and inflammations can affect the human temperament and indeed how there is in every one of our brains, a personality. She found TRIMED and we at TRIMED found the real Mrs. B.

From Heaven’s Door to the Emerald Isle

“Teach us to live that we may dread, unnecessary time spent in bed;
Get people up & about and we may save, our patients from an early grave!”
~Richard Asher, Legendary London Physician

by istockphoto.com
by istockphoto.com

Mr. P from Sri Lanka was brought to our attention, by another patient of ours Mr. A, who had benefitted greatly from our therapy. Four months earlier, Mr. P, a successful trader, had found himself developing abnormal sensations in his hands and legs, followed insidiously by progressive weakness. He went on to develop, over a month, problems with swallowing, speech and a host of other brain functions. As the family was concerned about his progressive illness, he was shifted to a major Chennai hospital. There he was diagnosed to have an acute inflammatory disorder of the brain, Acute Disseminating Encephalomyelitis (ADEM). After a fortnight in hospital during which time he received high dose intravenous steroids and a host of life saving procedures, Mr. P was discharged to home care and physiotherapy. A fortnight later, when the family found progress lacking, the TRIMED team was called in.

When we first met Mr. P he was bedridden, needing assistance for all activities of daily living; being fed by a Ryle’s tube, unable to speak, communicate, even indicate his needs. We were very concerned about his health and longevity. A brief admission in our affiliate hospital showed metabolic disturbances, probably a consequence of poor intake, needing immediate correction, as well as (in endoscopy by our discerning ENT consultant) significant oedema (swelling) of the laryngeal structures. He was stabilised in hospital over 5 days and discharged back to home care by the TRIMED team. We started our work with home based rehabilitation using a combination of Ayurveda therapies, mud therapy, physiotherapy, acupuncture, nutritional management and motivational counselling. In a week Mr. P was being mobilised from his bed to a wheelchair and was able to come to the TRIMED centre in his neighbourhood for intensive therapy. He was acknowledging his caregivers and attempting to communicate. In two weeks he started to stand with support and was able to swallow small quantities of blended food. He was able to speak a few words in a low voice. At the end of three weeks Mr. P was able to walk with assistance, eat most foods given to him; speak well enough to be clearly understood, eat normal meals and enjoy watching TV.

Today, four weeks on, from the time he found TRIMED, Mr. P is boarding a flight back to Sri Lanka. He came to Chennai in a stretcher and boarded a hospital ambulance, acutely ill. Six weeks on, he will walk through Chennai airport to board his aircraft. We hope he will continue to practice the TRIMED way, our one hour program combining hatha yoga, progressive muscle relaxation and ergonomic exercises. His wife, besides herself with joy, has pinned an inspirational message on your centre’s notice board.

No doubt Mr. P needed and benefited from acute medical care, which saved his life. But it was our rich TRIMED blend of modern medicine with ancient medical traditions that got him back on his feet, delivering care beyond cure. Mr. P’s journey to Heaven’s Door and his triumphant return to the Emerald Isle, is our continued well-spring of inspiration at TRIMED.

The Four-Legged Stool!

2366808When we first met Mr. A 8 years ago, he was doing his Masters in a prestigious American university. Rather devastatingly for him and his family he was diagnosed with Paranoid Schizophrenia, which had in the previous year impacted severely on his life and academic performance. Confused by his hallucinations and delusions, fearful for his safety and struggling to live alone, Mr. A was brought back to Chennai by his family. We treated his acute illness with psychotropic drugs, relaxation exercises, individual and family counselling and nutritional counselling (for his obesity, in part a consequence of his drug treatment). Within a month, Mr. A was able to return to his university and continue his course. He did of course have a few stable paranoid ideas and occasional mood swings.

Mr. A managed to stay on in university and graduate with a Master’s degree with ample family support. He progressed to secure a suitable technical position in a major multi-national computer manufacturing firm. Here, he was fortunate to be placed under a humane and empathetic boss. Over the past 8 years he has continued to visit Chennai annually for a course of multi-disciplinary therapy with our team. He also remains on fortnightly-monthly skype sessions with our clinical psychologist. He has had periodic exacerbations of mood changes with racing thoughts and paranoid ideas. He has wondered about the intentions of his fellow employees and become agitated in his interactions with them. He has had to take time off work to go and stay with his sister, in another part of the US, for a few days. He has on occasion, especially close to major life events (exams, role transfers) needed his parents to travel to the US and stay with him.

However, thanks to his own efforts, his uniquely supportive parents and sibling, a very supportive boss and mentor at work, and (in our belief) TRIMED therapy, he has managed not only to keep his symptoms under control, but to hold on to a job and climb the ranks at work. Back in India for his review and booster therapy sessions, Mr. A reported that his symptoms have almost remitted over the last year. This, despite his move to a new job at another respected multinational technology major. He is proud to share his weight loss efforts and to seek TRIMED’s assistance in meeting these goals. He has been diligent about his medicines, and has practiced the TRIMED way (relaxation, yoga and ergonomics) diligently, through the past year.

Mr. A is one of our “happy stories”. One who has been helped by the four legged stool: self-motivation, a supportive family, a supportive boss and adherence to the therapeutic relationship with the Neurokrish-Trimed team. He found and stayed with TRIMED and in him we find the raison d’être for our professional existence.

From Tasmanian Devil to Mathematical Whiz

WorldAutismDayMaster S first met the Neurokrish team (later to become the Neurokrish-Trimed team) about 5 years ago. Aged three years old at the time, he was brought to us by his grandfather who had recovered fully from a stroke, under our care. S demonstrated clearly to us the features of both Autistic Spectrum Disorder and Attention Deficit and Hyperactivity Disorder. He refused to maintain eye contact, engaged in fleeting social contact which was very poorly sustained and was yet to develop any language skills of note. More disturbingly, S was profoundly hyperactive and disruptive, so much so that he could in a few moments literally tear apart a consulting or therapy room, when left alone. Needless to say his extended family, especially his mother were distraught. In our minds S bore a striking resemblance to “Taz” the adorable but disruptive “Tasmanian Devil”, then a beloved cartoon character, much loved by the kids.

Taz was offered a combination of behaviour therapy, Neurodevelopmental therapy and family counselling. He was also prescribed medication to improve attention, stabilise his volatile moods and cut down his very disruptive behaviours. Over a 3 year period, our therapeutic relationship with Taz’s family evolved; together we walked many a milestone; his first words, his play school, kindergarden, and primary school. Therapeutic holidays from drugs during summer and winter vacations; the role of extended families, maternal and paternal; expectations of the many stakeholders, parents, both sets of grandparents, uncles and aunts; teacher and school interactions; our therapeutic relationship weathered these many storms. His GI problems responded to our Naturotherapy approaches; his limbs became dexterous and his fine motor skills including handwriting skills improved with Neurodevelopmental therapy and ayurveda. Thanks to sustained behaviour therapy and parental counselling he became less disruptive, could follow parental instructions and began to sit for longer periods of time. His attendance and participation at school improved dramatically; his intuitive mathematical abilities started to shine; he learned to interact better with peers and teachers. Indeed, not only did he survive primary school, he had even topped his class in mathematics.

Recently we met our “Taz” one final time, before he migrated with his family abroad. His evolved parents had declared his condition in the immigration visa application form and sought special assistance for him aided by a detailed summary from Neurokrish-Trimed.Taz still disrupts the room a little, butts into conversations, is impulsive, slightly stilted in his conversations but now showing warmth and willingness to communicate. Taz has a combination of ADHD and the ASD spectrum and is one of our most challenging child patients ever. Yet, his remarkable progress, made possible by the wonderful therapeutic relationship our team had with his family, holds hope for many other children, affected just like he is. We do hope he will continue his progress abroad.

From S and his family we have learnt the importance of looking beyond terminology and the diagnosis. After all, mere words do not the person make!

The Kundalini in Our Bowels!

220px-DiagrammaChakraKundaliniWhen Mrs. S, the wife of a practicing physician, first approached us, she been suffering with an uncontrolled appetite and irritable bowels for over two years. She was eating every two hours, had gained over 10 kgs, and had to visit the loo at a similar frequency. She had consulted an army of medical specialists, had been labelled “neurotic”, “anxious”, and a variety of other disparaging terms. At TRIMED, our 360* assessment of her TRUE HEALTH revealed one very important aspect that perhaps had not been identified in her myriad scans and tests- Mrs. S had several features of autonomic dysfunction, although she was otherwise in perfect health.

When we first prescribed our Trimed Therapy Gastro disease management program for Mrs. S, she and her family were disbelieving; that using a combination of alternative medical approaches, our very special brand of integrative medical therapy, would help. Nevertheless, desperate as she was, Mrs. S committed herself to a TRIMED program that included a detoxification process, diet, yoga, progressive muscle relaxation exercises, as well as sessions of therapy both with ayurveda oils and therapeutic mud. The only allopathic input from us for this program, was to introduce a ion channel stabiliser and continue her prescription of lactobacillus and pantoprazole (both longstanding).

Over a month Mrs. S started to report an improvement in her symptoms. Her bowel movements began to stabilise and her visits to the loo halved. Her appetite too became more stable and manageable, with her managing her diet with smaller frequent meals. Three months on, Mrs. S reported normal bowel movements, a healthy appetite but with regulated diet, stabilisation of her weight and greatly improved quality of life. Mrs. S found TRIMED and in her we found the silent cause of numerous symptoms, autonomic dysfunction- the aspect of human physiology that our ancient texts focus on as the kundalini.