A Himalayan Odessey

@mediawiki
@mediawiki

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as he had been having difficulties with walking, could not perceive depth, experienced poor memory, and had become withdrawn, fearful and depressed.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 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 Man Behind the Dementia Mask !!

 

iStock.com
iStock.com

When the TRIMED team first encountered Mr. R aged 61 years, he was curled up on his bed in a fetal position, doubly incontinent (for both urine and faeces), barely taking in a few sips of liquid and a few mouthfuls of food each day. He was mute and had last communicated with the family in a meaningful way about 4 months earlier. According to the family he had been suffering from memory loss for over 3 years and had experienced considerable worsening in his clinical condition in recent times. His wife of 35 years was beside herself with anxiety at his declining health. It was his son, visiting from the US, moved by the plight of his beloved father, who found TRIMED.

At TRIMED Mr. R was first put through a “360* Assessment”- a measure of his TRUE HEALTH, in which our family physician, ayurved, naturopath & yoga doctor, physical therapist, clinical psychologist and nutritionist evaluated him. A detailed blood profile, brain imaging, electrophysiological tests and expert neuropsychiatry opinion from the Neurokrish team, completed our work up, revealing surprisingly few bodily aberrations that we proceeded to correct. He was started on suitable allopathic drug treatment for his condition, including anti-dementia drugs and vitamin supplements. Mr. R was inducted into TRIMED’s disease management program for dementia and over 3 weeks received nutritional therapy, ayurveda treatments, reflexology, physical exercises & mobilisation, and motivation enhancement training. Drawing him out of his cocoon in a few days, the TRIMED team soon had him up and about, taking part in his therapeutic program with increasing interest, eating well and sleeping normally. Caregiver education about dementia was effectively delivered and cognitive retraining instituted, reminiscence therapy being a particular forte among our counselling psychologists.

Today, 6 weeks on, Mr. R strode into our TRIMED centre confidently for his review appointment. With a beaming smile he greeted us appropriately with a “namaste”. He continues to have recent (and some remote) memory disturbances and to confabulate (make up) his replies. However his social behaviour and interactions are appropriate, he recognises his family members and addresses them suitably, is eating, sleeping and exercising well. Indeed he even follows “the TRIMED way” our one hour exercise protocol, with a bit of prompting. Mr. R’s son is leaving for the USA this week, a happy man. He found TRIMED for his father, and in his father TRIMED found “the man behind the Dementia mask”.

We at TRIMED are inspired every day, by people like Mr. R, their families, and the power of “modern healthcare with ancient wisdom”.