BRAIN INJURIES SUCK

Josh is now suffering from a condition called orthostatic hypotension.  This condition is a total and complete drag because it sometimes causes Josh to pass out.  Orthostatic hypotension causes a person's blood pressure to suddenly fall when standing up or stretching.  Medically it is a drop in the systolic blood pressure of at least 20 mms and a drop in the diastolic blood pressure of at least 10 mms when a person assumes the standing position.  Josh used to have a very high metabolism.  He would go to the gym with Don and work out like mad.  He'd get on one of the machines and burn 500-600 calories.  Now it is as if Josh is in slow motion.  He acts as if he is running out of batteries.  He is slow and lethargic.  A few times like today he has passed out and ended up in the Emergency Room of Scripps Hospital.  It is just horrible.  When Josh passes out, it is in the morning.  When this happens, I call 911. The paramedics come to the house, hook Josh up to an IV and take him to the ER.  I follow along in the car, panic-stricken and scared to death thinking "Why is this happening?  We were doing so well and now this?!"  

Here is Josh in the ER smiling away in spite of his condition.

Today I decided to research the causes of orthostatic hypotension and try to figure out what could possibly cause Josh to go from one extreme to another.  Why was he full of energy many months ago?  Why is he now lethargic and slow?  Well, a possible cause of orthostatic hypotension is the long term use of Lexapro, an anti-depressant.  Josh has been taking Lexapro every evening since he had the brain injury.  That's six years of accumulated Lexapro in his system.   The doctors explained that Lexapro could be calming to Josh and help lessen his libido.  These are good things as you don't want an aggressive, brain injured 20-something-year-old craving sex and acting inappropriately.  HOWEVER, you don't want your kid passing out either.  So, what do you do?  The cardiologists prescribe Midodrine which increases your heart rate.  Josh takes 5 mgs of Midodrine three times a day -- at 9 a.m., at noon and at 5 p.m.  So, now Josh is on two meds - one to calm him down, decrease his libido and cause orthostatic hypotension and one med to increase his blood pressure due to the side effect of the Lexapro which most likely caused the orthostatic hypotension.  It's kind of crazy.  I have decided to give Josh a smaller dose of the Lexapro (2.5 mgs which Dr. Stenehgem suggested) and continue with the Midodrine for a while, but to closely monitor Josh's blood pressure.  Midodrine can cause high blood pressure which is not a good thing.  

On a good note, Josh is very calm now and very appropriate.  He used to have no filter which is very common with brain injuries.  For example, a year or so ago, if Josh saw a very beautiful girl, he would walk up to her and give her a hug.  This is unfiltered behavior and can be offensive.  Josh does not do that any more.  He is reserved.  A year or so ago, if Josh saw someone that looked Hispanic, he would immediately start speaking in Spanish to that person, "Hola, como esta?", he would say.  This would, at times, offend the person.  Josh does not act like that anymore. When I bring Josh with me to the office, he will watch a movie on his PSP or play Lumosity on the computer or go on Facebook.  He is quiet and sticks to the task, sometimes for hours intently concentrating on whatever it is he is doing, totally oblivious to his surroundings.  A year or so ago, Josh would talk to every customer that came into Reliable Pipe.  He would blurt out, "What's your name?"  Those days are gone.  We now have the new and improved, reserved Josh.  I guess that is progress.  It is certainly easier to manage Josh when we go places.  It is easy for Josh's caregivers.  They like hanging out with Josh because he is easy and appropriate.  It is just so strange how brain injuries work.  

Josh is now 26 years old.

12/26/12

Happy 26th Birthday, Josh!

You have come a long way!