Tag Archives: Alzheimer’s

Who Are You?

Dementia: The Brain Killer.

© Dr. Rajas Deshpande

“Just a month ago dad / mom was alright, but now replies in a word or two, appears disinterested in anything. He / she was very lively and active earlier, we are surprised that now they just sit without doing anything, usually staring out of the window, and have to be reminded for everything – food, bath and even who we are’. These words alert every doctor about dementia- a disease that is extremely scary, because the brain is slowly dying. The person suffering with this illness, if not attended in time, can deteriorate permanently and fast, forgetting even oneself, without knowing that this is happening.

What if your own brain forgets you? What if you start to complete fail to recognise your own family, children, friends, not only their names but even their faces, how much they mean to you? Worse, what if in fact you start thinking that they are after your life? Impossible, you think? Welcome to dementia, a devastating disease of the brain that shatters many of our conceptions about ourselves and the world around.

Human brain does a lot more than thinking, speaking, memorising and walking. Born nearly empty, with only basic animal instincts, it then starts filling the memory cells with whatever information is fed to it- name, caste, religion, country, culture, food habits, and also the preaching of dying for one’s own religion or country. While acquiring different skills, it starts comparing self with others, instils the cultural concepts of loving or hating others, discriminating, superiority, and even the wish for equality found in some evolved cultures. Whatever we learn and the emotional make up of our minds, is a stored data in our brain.

Add the bittersweet experiences, the eternal exposure to a mostly self-centred world and our insights, all these make up the personality of each individual, even the ego of being that person, and the addiction of thinking ‘me first’ – all of it is in fact ‘stored data’ in the cells of the brain. There’s also information necessary for communication and social interaction: from days of the week to awareness of day and night, where we are, people and environments around us and so much more.

What happens when these brain cells start dying, degenerating? All this starts fading, and the brain starts having large gaps in these storages about everything, including self. This disease starts slowly, and unless someone is having daily meaningful conversation with the patient on a daily basis, it is missed for many initial months, because the regular, hi-hullo type of conversation is preserved till late. Even the most brilliant minds start making notes and reminders, often forgetting where they kept those. They appear withdrawn, lost in thought, and often have difficulty remembering names, relationships and directions- like not knowing where the washroom is. Some of the most disciplined and cultured may also start using vulgar abuses, have spells of rage, and may accuse their beloved spouse / children of having affairs, intentions of harm and stealing. Some take off clothes in public, misbehave, leave home and get lost outside. All this because the stored memories of “What not to do” is also being lost with brain cells dying. There are many types of dementias other than Alzheimers. Some are treatable if diagnosed early.

The loved ones of such patients are usually shocked and devastated, not only with the diagnosis, but with the revelation that in many cases this is permanent. They usually think that it must be age, stress or some anger that led to this, but their frustration is usually vented at the doctor when they realise that things are progressive. Visiting quacks in various pathies who exploit hope and frustration, the patient is subjected to much experimentation, abuse and even cruelty like tying them down, beating them up, etc., thanks to our superstitious society. The real tragedy is the waste of precious time- because starting the right treatment may some parts of memory longer, and reverse some types of dementias.

The right counsellors, psychiatrists or physicians recognise the disease easily and refer the patient to a qualified neurologist in time. Certain dementias due to deficiencies of thyroid hormone, Vitamin B12 etc. and depression are reversible to a fair extent, while others may require lifelong treatment with a neurologist. If started early with the right medicines, many cases improve and sustain for months to years.

Many cases of dementia are unmasked when patients undergo surgeries, hospitalisation. Patients with dementia get scared and confused in new surroundings, change of familiar places or absence of near and dear ones. They may have many psychiatric manifestations, and even become aggressive. The most emotionally draining thing is their paranoia and accusing spouse of infidelity.

It is essential to counsel and train the family and caretakers about how to handle such patients. One needs to detach emotional interpretations of patient’s behaviour and treat them like a child. One must never force such patients- to eat, sleep, exercise or do something against their wish (unless of course if they intend to harm self or others). One must also refrain from continuously correcting them, teaching them logic and reasoning, or asking them things they cannot remember.

Who Are You? Is an extremely difficult question to answer. Whatever you are, it exists only in your brain. Take good care of it. Stay away from negative emotions of hatred and discrimination. Don’t compare yourself with others. Practice equality in its true sense, it brings calm. Eat healthy, stay happy and active. Include almonds, walnuts, fresh fruits and vegetables in your daily diet. Control blood pressure, sugars and cholesterol levels.

Avoid red meat, butter, fatty and fast food. Avoid unknown medicines.

Many consider deceit and lying as “essential diplomacies” for success, and happily sacrifice precious personal relations in a quest to succeed for money and fame. Guess who helps us when we forget who we are. Preserve your relationships, speak your mind to your close friends, near and dear ones. Share your feelings, express your desires. Shed egos and reach out to people you like, make up with them. Do this today, because tomorrow it may be too late.

© Dr. Rajas Deshpande

Neuroloigist

Pune, Mumbai.

9922753753

Please share unedited for awareness

The Tortured Beloved

The Tortured Beloved
© Dr. Rajas Deshpande

“I want to kill my father, Doc. Is there any way?” said the polished lady.

Used to a life full of shocks, cruelty and in general many negative shades of human behaviour, we learn to mask emotions to avoid turning off the patient /relative from telling us the whole truth.
This was a googly, and I made a conscious effort to retain my composure.

Thirty-something, very posh and from a high class cultured family, this lady was one of those who automatically garner respect of people around them. What she said didn’t fit in with the mental image she had impregnated upon my mind. Could she be one of the “PSY” cases?

“I live with two daughters aged 9 and 14. My mom passed away 10 years ago. My husband stays away as he cannot tolerate my father. My father was a military officer, retired with many honours. About 5 years ago he started forgetting things. We took him to many doctors all over India, they said he had dementia. Two-three years ago he started abusing in the worst filthy and obscene language we never thought he could use. He also started getting naked anywhere, and doesn’t care if myself, daughters or neighbours are around. He passes urine deliberately when in public and around us. He also makes attempts to sexually abuse us all, and tried more than once to grope the maids, who then left. We had a hard time when a maid filed a police complaint. I could not dump him as no one else can look after him. So I nursed him at home, and my husband who could not tolerate this daily abuse left us to stay in another state.” She started sobbing. All I could offer was a few tissues and a coffee.
I waited for her to speak again.

“I am sorry”, she said in a wet, guilty, embarrassed and one of the most pained voices I have heard. “I love my father as much as I love my husband. I could not dump my father. But then I cannot let my daughters go through this every day. They are terrified and have started behaving strange. We took him to many psychiatrists, and they gave medicines which kept him calm, but he developed too many side effects and could not move out of bed. Now he refuses to take any medicines and if we force him, he gets violent.” Again amongst sobs, she showed me her blue-black swollen shoulder.
“I have to tie him up to his bed and lock his room at night, but he keeps shouting. Our neighbours have started asking us to either dump him or move out of the society. The old age homes do not accept such patients.”
“I am a personality development counsellor, but my work is suffering now, I have lost my smile. I have lost my life. I cannot die, I have two kids to grow up. So I want my father to die. Is there any legal / medical way to kill him?” and then a volcano of unvoiced pain of years wailed out through her throat. She kept her head on the table and cried.

It was unprofessional, but I had to get up and pretend to wash hands just to be able to wipe tears in my own eyes.

Fronto-temporal Dementia, a cousin of Alzheimer’s dementia is a condition in which along with progressive memory loss, there is abnormal behaviour, delusions, sexual inappropriateness etc. It happens due to degeneration in some parts of brain. Progressive for about five-12 years, till patient develops some fatal complication.

This was not totally new. I remember many patients who are tied up at home, beaten up cruelly by their family, and left to die due to this kind of behaviour. This tragic management is also commonly meted out to many psychiatry patients who are burnt, injured with sharps, shackled and tied to beds / trees, kept with head under running water and even poisoned / sedated with herbal or even allopathic medicines to ensure safety of those around them.
Few years ago, one family of bodybuilders (all five brothers in land business) admitted their father with the complaint “he burnt himself with hot water in bathroom”. There were many bruises too. “He fell at home.” They told. When the sons left, the servant told the resident doc: “They (patient’s sons) threw boiling water upon his genitals after tying and beating him, because he tried to touch his eldest daughter in law”. This patient had severe parkinsonian features too, so was not able to move much due to stiffness. They had beaten him up and burnt him in that condition!

The lady in front of me regained her calm in few minutes. I explained her what many Neurologists and Psychiatrists may have earlier told her many times, about such being the nature of this disease. However, we have many safer medicines to control psychosis now. I wrote her a prescription and promised her that I will try and locate a “Care center” for such patients with this severe level of psychosis. There were none in that city. The next option was to hire a male servant and rent a small single room apartment with attached toilet nearby where she could shift her father. Sedatives (sleep medicines) at night were required.
Her husband shifted back. The family appeared to gradually recover from the mad-bad days.

As much as we need the doctors to explain the family about such illnesses, we also need to educate the society about such conditions, and care homes for these patients. Inhuman beating up, tying down, injuring, poisoning etc. humiliating fates by one’s own children is probably the worst that can happen to a human being.

When the lady came to visit with her daughters few months later, her cute daughters wished me mannerfully. We all grown-ups avoided the topic of “Sick Grandpa”. However, the 9 year old, while leaving, boldly asked her mom’s permission to ask me a question.

Then, looking straight in my eyes, the kid asked me “Doc, why did God do this to my Grandpa? Is it possible to cure him? We used to enjoy so much together, I was his dearest. It is ok if he hurts me, I want him back”.

I cursed my stunned wits. “He will get better soon, dear” I lied to the cutie.

© Dr. Rajas Deshpande