Showing posts sorted by relevance for query Tips:. Sort by date Show all posts
Showing posts sorted by relevance for query Tips:. Sort by date Show all posts

Sunday, May 24, 2020

Blog #118: MORE HELPFUL INFORMATION ON YOUR EPILEPSY AND SAFETY DURING COVID-19 PANDEMIC


My blog last month provided tips for people with epilepsy to stay safe in the context of the Covid-19 Pandemic (Tips: Your Epilepsy in Our New Covid-19world). The Epilepsy Society of the United Kingdom offers helpful tips for keeping people with epilepsy safe during the Covid-19 pandemic. This month I share their tips to help keep people who have epilepsy out of clinics and hospitals where contracting the virus can be a larger threat.

·        People with epilepsy are at no greater risk of contracting Covid-19 than anyone else unless you have an additional risk factor such as old age, immobility, respiratory disease, severe heart disease, diabetes mellitus, hypertension or are immunosuppressed. These same risk factors also apply to the general population without epilepsy.
·            Wash your hands frequently and do not touch your face.
·         Isolation from and avoiding contact with symptomatic individuals during this pandemic is paramount to staying healthy.
·         Wear a mask when others are nearby and keep at least 6 feet away from another person.
·         People who have epilepsy are generally experienced with their own condition and know what triggers their seizures, so do what you can to minimize this risk. Triggers may include: skipping/forgetting to take anti-seizure medication, lack of sleep, poor nutrition, recreational drugs and alcohol, etc. If you know flashing lights and computer games set your seizures off, avoid them as well.
·          Make sure you have an adequate supply of medications on-hand to avoid or at least limit contact with people in pharmacies and clinics where risk of exposure to the Covid-19 infection is greater. Familiarize yourself with obtaining medications through online pharmacies, where feasible.
·         To make compliance with medication easier, use pillboxes to increase accuracy and regularity of medication dosages during the day by using pillboxes or cell- phone alarms or phone apps.
·         During this health emergency, consultations with your caregiver should be available by telehealth internet mechanisms and telephone. Establish this communication system before they are needed in a panic-mode. Ask your health team in what situation you should go to the clinic or emergency department before you head out, to avoid unnecessary exposure or travel.
·         Your companion/caregiver needs to be included in your discussions with your neurologist/physician/nurse to determine what to do if you have multiple seizures over a short time-period, or if you have a prolonged convulsion lasting over 5 minutes. Also make plans what to do/should be done in a similar situation if your companions/care givers at times are not available. For this reason, it’s always a good idea to wear a Medi-alert bracelets/necklaces in case you ever need emergency care and are unable to communicate or provide information about your epilepsy to medical personnel or first responders.
·         To minimize the risk of injury during a seizure, only use the front burner when you are cooking. (I have seen severe burns in patients seizing and falling on flames/hot coils/hot pots while cooking on a front burner.) If possible, try to avoid taking a bath or shower when no one else is at home  and keep the bathroom door open for easier access by a companion. Shower drownings can occur, too, if you fall face-down and block the drain.
·         Avoid holding a baby over bathwater when bathing the child or holding the baby while cooking. If you have a seizure at these times, your baby is at risk, too.
·         Helplines are available through local epilepsy societies and support groups for people who would benefit from emotional support, such as for anxiety and depression. Epilepsy-service-dogs can be extremely supportive, too. (See my blogs #109, August 26, 2019; blog #72, July 26, 2016 and blog #9, December 14, 2011 that discuss service dogs at www.LanceFogan.com.)

Stay safe! The above suggestions can help you do that.


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Saturday, April 25, 2020

Blog #117: TIPS: YOUR EPILEPSY IN OUR NEW COVID-19 WORLD


Now that we’re secluded in our homes do we live alone or with others?

Safety in dealing with the Corona Virus-19 starts with minimizing/avoiding close contact with other people as much as possible; wearing a face mask over both your nose and mouth to try to avoid spread of nasal/oral droplets and avoid contact with other people to minimize spreading the virus. Even if you are asymptomatic these actions should be done when around others and even more so if you believe you have mild cough, fever, aches and headaches. During this spring-time season, allergies usually cause running nose, itchy eyes but do not cause fevers. One tell-tale symptom of Covid-19 can be altered or loss of smell and taste; this is uncommon in other types of infections.

 
Fevers and viral infection syndromes commonly lower resistance to epileptic seizures. Spending more time in front of your computer screen exposed to flashing/flickering lights and geometric patterns such as checks or stripes in computer games can provoke seizures in up to 5% of those people who have epilepsy of the photosensitive epilepsy-type. Flickering overhead lights, sunlight through blinds and fast-moving figures on television screens may also trigger seizures in these people, too.

Tiredness and getting insufficient sleep are known triggers of seizures in people with epilepsy so be sure to get enough rest and take your anti-seizure medications as directed. Avoid drinking alcohol; alcohol can bring on seizures in epilepsy. Your doctor should be available for telephone consultations when desired if face-to-face meetings are not necessary during the Covid-19 pandemic.

As always, take precautions in your home. Be sure not to bathe/shower unless someone else is home with you whenever possible and keep the bathroom door open. I know of 17 patients who drowned in the bathtub (over a century ago Mark Twain’s adult daughter, Jean, had epilepsy and was found drowned in the bathtub) including 5 who fell face-down in the shower blocking the drain; they drowned in just 2 inches of water. Younger children bathing when mother can’t stay close should have the child sing. If singing stops mom should rush to check the child. When you cook, use only the rear burners to avoid falling on to hot coils, flames, and on to hot pots should you have a seizure at the stove.

You stay safe! The above suggestions can help you do that.


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Thursday, March 25, 2021

Blog #128: A FAMILY DEALS WITH UNRECOGNIZED EPILPESY: Excerpted from Dr. Lance Fogan’s novel, DINGS Chapter 24, Part 2

 In the Neurologist’s office—making the diagnosis

 

The doctor looked at me. “Mom, can you tell me what happened?”

I described that evening: Conner sneezing and coughing in his sleep, his high temperature, hearing the strange noises coming from his bedroom, finding him jerking all over the bed, the wet sheet and blanket, all that blood in his mouth…

“My tongue got bit. It still hurts!” Conner blurted. He opened his mouth. “Thee?” He lisped as he protruded his tongue.

We all looked at the almost-healed blue laceration.

I heaved a sigh to slow my breathing. I put my cold fingers under my thighs to warm my hands. “Then there was that rush to the hospital and Dr. Choy.”

Dr. O’Rourke glanced again at the hospital notes in front of him on his desk. The neurologist smiled and drew a deep breath.

Before he could continue I sat forward and interjected, “Doctor, I, uh, we were hoping”—I flashed a glance at Sam’s querulous face—“Uh, we were hoping to stop the Dilantin as soon as possible. Do you think that we can?”

“We’ll see, Mrs. Golden. Dr. Choy did a thorough job screening Conner for causes of that seizure. I see that he put Conner on Dilantin. That medication may not be necessary. Your boy is a bit old for his convulsion to be secondary to just a fever, though. Let me find out a bit more. I need more information.”

I beamed at Sam and squeezed his hand. Yes! He was confirming what I had learned from the Internet. The neurologist just said what I had been praying for. I leaned back in my chair.

But, he said that he would investigate further. That was when I pictured a detective with a baying hound that scurried right and left over the ground smelling out prey. So there it was again. Something wasn’t right for these doctors. Dr. Choy had said something like that about the convulsion and Conner’s older age, too. What wasn’t Dr. O’Rourke telling us? I got the feeling that he was taking care not to terrify my already-shaken family. I don’t exactly know why—I felt some ominous undertone.

Dr. O’Rourke asked, “Has Conner ever passed out or fainted in the past?”

“No. But, you know, I wanted to ask you: Sam’s brother had something similar when he was an infant. He had a fever then, too. That was the only time it happened though. Right, Sam?” Sam nodded. “I’ve heard that seizures can run in families. Is that true? God, I hope not…” My voice trailed off.

“They can.”

I clasped my hands and leaned forward. Then I sat on my fingers again.

Dr. O’Rourke turned and addressed his patient. “Conner, have you ever blanked out when you’re thinking about something?”

“Uh, like…what?”

I looked at Conner. Sam did, too. Why did Conner say that? I got this uneasy feeling that Conner somehow understood what the doctor was hinting at. Sam’s mouth dropped open. He looked at me; his eyes narrowed.

The neurologist cleared his throat and leaned forward over his desk. “I mean, let’s say that you’re thinking about something, or watching a movie or a TV program, or someone is talking to you. Does it ever seem as though you suddenly missed what was happening? Like your mind went blank all of a sudden. I don’t mean daydreaming; everybody does that. When you daydream, your mind is still thinking of something—like you zone out—but you know it. Let’s say something is important to you and you are really paying attention.”

Dr. O’Rourke stole a quick glance at Sam and me. Then he looked back at Conner and continued, “And then, all of a sudden, the scene in the movie or on the TV screen has changed, and—” He clapped his hands once. “Suddenly you don’t know what happened, even though you were following the story really closely. Has that ever happened to you?”

Conner leaned forward in his chair and dug his fingers hard into the edge of the doctor’s desk. I saw white at their tips. “Well, um, sometimes I get these, uh…you know, I get this funny, this ding feeling. I don’t know, I—I—and then something else has happened and I don’t know what.”

What? Sam and I looked at each other. My jaw dropped. My body tightened and my voice was loud. “What do you mean, Conner? What ding feeling? What are you saying? When does this happen?”

He turned toward me. “A lot. When it happens at school Mrs. Dorsey gets mad at me.”

“Mrs. Dorsey gets mad at you? What do you mean? Why? What happens?” I grabbed his arm.

I looked at Dr. O’Rourke. He sucked in his cheeks and his lips pursed as he slowly nodded his head one time. His eyes moved down to my hand that gripped Conner’s arm. Otherwise, he maintained a placid expression as he watched us.

“She asks me if I…um…if, uh…I need more time to do my tests. Like that spelling test. She said I needed more time…um…to finish.”

“Did you finish? Did you need more time? Which was it?”

“I—I don’t know. I don’t know!” Conner’s chin quivered.

Dr. O’Rourke picked up his pencil and held it poised over his notepad. “What you’re telling us is very helpful, Conner.”

I released Conner’s arm and leaned back in my chair. As my legs straightened, my shoes kicked the bottom of the neurologist’s desk. What was he saying? None of this made sense.

Dr. O’Rourke licked his lower lip. “How often does this happen, Conner? This ding?”

Conner shrugged. “I dunno…I dunno. I don’t!”

“Well, what would you say? Does it happen every day? Does it happen every few days, or every few weeks or months?”

“I dunno. A couple of times, I guess.”

“Did it happen today?”

“No.” Conner sniffled.

“Did it happen yesterday, Conner?”

“No.”

“Does it happen a lot?”

 “It doesn’t happen every day…I think.” He shuddered and hiccupped back a sob. He looked at me. Tears started to roll down his cheeks. His chin trembled. When I leaned over to wrap my arm around his shoulders he sobbed louder. “I’m scared. I’m scared, Mom!” He wiped his cheek with his sleeve.

I stared out and couldn’t move for a moment. I was in slow motion. Everything was in slow motion. I took some tissues out of my pocket and began to wipe his tears. My ice-cold hand shook. “Don’t be scared, honey. You’re doing fine.”

My gaze darted between Conner and the doctor. Sam stared at our son; his cheek muscles rippled.

“Yes, you are doing just fine, Conner. This is very good, very helpful.” Dr. O’Rourke kept his gaze fixed on his patient. “Now, do you ever imagine that you smell something that’s not really there, that nobody else can smell? Do you ever get a taste that just came into your mouth without eating anything?”

Conner gave a tiny nod.

“Is it a smell or a taste, Conner?”

 “I think I smell something…um, uh…but I don’t know what it is.”

“Well, is it like something bad, Conner? Like, burning rubber? Something like that?”

“Yeah!” Conner’s face brightened. He nodded vigorously. “That’s it! That’s what it is. It smells like the things Daddy burns in the yard at work.” Animated now, he scrunched up his nose and his body rocked back and forth as he nodded. “It’s gross,” he added.

I couldn’t believe what I was hearing. I looked at Sam. What was Conner talking about? Why had he hidden this?

The neurologist continued, “And then what happens, Conner?”

“I don’t know!” Conner wiped his nose on the cuff of his shirtsleeve.

Dr. O’Rourke turned to me. “Have you ever witnessed one of his ding spells? Have you talked with his teacher about them?”

“I don’t even know what Conner is talking about. I’ve never seen anything like that!” I looked at Sam. “Have you? He’s never said anything about them to me.”

“No. I’ve been away so long. I served in the Army in Iraq this past year, Doctor. I just got back two months ago.”

Dr. O’Rourke held his gaze on Sam. “I see.”

“The school had him evaluated by a school psychologist because he wasn’t completing his class assignments,” I volunteered. “Everybody thought his problem was stress from, you know, because his father was deployed in Iraq. I arranged for him to be treated by a psychologist, Dr. Frank Thomas. Conner has already seen him a few times.”

Conner lowered his head and curled his fingers in his lap.

“I know him.” The neurologist nodded.

“Could these spells be causing him to fall behind in school? You know, it turned out that his teacher from last year thought he could do better work then, too. They had no idea why he was not. And now, you’re saying that these things…these things could have…could have been going on for a whole year, Doctor?” I turned to Conner. My eyes narrowed and my voice got louder. “Conner, these have been happening for a year? Or more? Why didn’t you say something, honey? Why didn’t you tell us?”

“Sandra.” Sam reached for my hand. I snatched it away.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.