“Cerebral palsy is an umbrella term that refers to a group of disorders affecting a person’s ability to move. It is due to damage to the developing brain either during pregnancy or shortly after birth.  People who have cerebral palsy may also have visual, learning, hearing, speech, epilepsy and intellectual impairments.”



Cerebral Palsy is a damage to a part of the brain and depending where the damage is will tell what symptoms to expect but for starters lets understand what is affected by this disease.


You have parts to the brain dividing it in a simplistic term, right now, take 2 sections:

1=Cerebrum is for thinking, muscular functioning both in our control (ex.muscle movement of our extremities) and not in our control (ex. the indicating of neuro=stimulation to tell the brain it’s time to urinate through neuro impulses from the bladder to the brain who tells us get up and go to the bathroom but through out muscle control we hold it till we get to the toilet).

2= Cerebellum for is for balance.  Cerebellar damage produces disorders in fine movement, equilibrium, posture, and motor learning in humans.

Cerebrum vs Cerebral Cortex

The nervous system is important to control and coordinate all the actions of an organism and transmit signals between different parts of the body. The system is basically made up of specialized cells called neurons. The complexity of the nervous system increases with the complexity of the body of organisms. Most primitive animals like sponges, flatworms have a very simple nervous system while advanced animals like vertebrates have a highly complex nervous system with larger brains. Brain is one of the largest and most amazing organs in an organism that can be categorized under the central nervous system. The human brain can be divided into three categories, namely, forebrain, midbrain and hindbrain. Both the cerebrum and cerebral cortex come under the forebrain.


Cerebrum is the largest and most prominent part of the human brain. It appears to envelop the rest of the brain as it constitutes 4/5 of its weight. It is split longitudinally into two large, prominent hemispheres; left and right by deep median fissure called ‘cerebral fissure’. These two hemispheres are connected through a horizontal sheet of nerve fibers known as corpus callosum. Each hemisphere is further divided into the frontal, parietal, temporal, and occipital lobes by three deep fissures, namely, central, parieto-occipital and sylvian fissure. Each hemisphere receives sensory input from the contra lateral side of the body and exerts motor control over that side. The basic function of the cerebrum is to control voluntary functions and seat of intelligence, will power, memory, reasoning, thinking, learning, emotions, speech etc.  The cerebrum is made up of 5 regions.  It deals with our sensory and motor and thinking function.

Cerebral Cortex

The layer of gray matter, about 2 to 4 mm thickness, on the outer surface of the cerebrum is called the cerebral cortex. In humans, the cerebral cortex is densely packed with over 10 billion nerve cells (about 10% of all the neurons in the brain) and, therefore, much of the neural activities of the cerebrum take place within this layer.

The outer surface of the cerebral cortex is highly convoluted (twisted or coiled and involved), and this convoluted surface increases the surface area of the cerebral cortex. The ridges of these convolutions are called ‘gyri’ and depressions between them as ‘sulci’. Each region is responsible for a particular function. According to the function or activity, the regions of the cerebral cortex can be divided into three general categories motor, sensory, and associative (they work together).

The motor cortex is generally associated with the movement of body parts and sensory cortex such as auditory cortex, visual cortex etc. is associated with sensory organs. There is a portion of the cerebral cortex which is not occupied by motor and sensory cortices, known as the ‘association cortex’. This region is devoted for higher mental activities, so that in higher primates, especially in humans, it covers 95% of the total cerebral cortex surface.

What is the difference between Cerebrum and Cerebral Cortex?

  • Cerebral cortex is a part of the cerebrum. Cortex means the outer region of an organ.
  • Cerebrum is the largest and most prominent part of the brain (it makes up 4/5 of the brain). Cerebral Cortex is the outer layer of the cerebrum.
  • Cerebrum has both gray and white matter while the gray part of it is considered the cerebral cortex.
  • Human cerebral cortex is made up of approximately 10 billion nerve cell bodies and their dendrites=the branching process of a neuron that conducts impulses toward the cell to allow a function to take place that the cerebral cortex does; whereas the cerebrum has both cell bodies and nerve fibers.

The part affected in Cerebral Palsy is the Cerebral Cortex.

Cerebral palsy (CP) refers to a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination Cerebral palsy (CP) is caused by damage to or abnormalities inside the developing brain that disrupt the brain’s ability to control movement and maintain posture and balance. The term cerebral refers to a part of the brain=cerebrum; palsy refers to the loss or impairment of motor function (in varying intensities).  Remember each pt diagnosed with this is unique with problems and intensities but maybe similar to some who have it also.

Cerebral palsy affects the motor area of the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement.

In some cases, the cerebral motor cortex hasn’t developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent.

Cerebral Palsy is a condition in which there may be abnormal brain development or injury to the brain as it develops. This can occur before, during, after birth or during early childhood.

It is the brain’s control over various sensory, muscle or co-ordination functions that is affected. So, although there is no injury to the hands or legs themselves, a child with Cerebral Palsy may not be able to walk or move his or her hands in a co-ordinated purposeful way.

Depending on which part of the brain is affected, the Cerebral Palsied person may not be able to talk, see, hear or understand normal thought processes.

Children with Cerebral Palsy have difficulties in controlling muscles and movements as they grow and develop. The nature and extent of these difficulties may change as children grow but Cerebral Palsy itself is not progressive: the injury or impairment in the brain does not change. However, the effects of the brain injury on the body may change over time for better or worse.

Physiotherapy and other therapies can often help people with Cerebral Palsy reach their full potential and become more independent. Therefore, children with Cerebral Palsy will often be referred to a therapist or see a multi-disciplinary team. Depending on the precise area of the brain that is affected, there may be associated difficulties which become obvious during development; for example, in vision, hearing, learning and behaviour.




“It is estimated that up to 48% of adults who meet criteria for ADHD may not have had a conversation about their symptoms with a healthcare provider.”

Part 2 ADHD AWARENESS – Problems Adults have that are diagnosed with ADHD!

What is Attention Deficit Hyperactivity Disorder (ADHD)?

Attention deficit hyperactivity disorder (ADHD) is one of the most well-recognized childhood developmental problems. This condition is characterized by inattention, hyperactivity and impulsiveness. It is now known that these symptoms continue into adulthood for about 60% of children with ADHD. That translates into 4% of the U.S. adult population, or 8 million adults. However, few adults are identified or treated for adult ADHD.

ADHD in Adults

Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks, or completing work within time limits. If these difficulties are not managed appropriately, they can cause associated behavioral, emotional, social, vocational, and academic problems.

Adult ADHD Statistics

  • ADHD afflicts approximately 3% to 10% of school-aged children and an estimated 60% of those will continue to have symptoms that affect their functioning as adults.
  • Prevalence rates for ADHD in adults are not as well determined as rates for children, but fall in the 4% to 5% range.
  • ADHD affects males at higher rate than females in childhood, but this ratio seems to even out by adulthood.

Common Behaviors and Problems of Adult ADHD

The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties:

  • Anxiety
  • Chronic boredom
  • Chronic lateness and forgetfulness
  • Depression
  • Difficulty concentrating when reading
  • Difficulty controlling anger
  • Employment problems
  • Impulsiveness
  • Low frustration tolerance
  • Low self-esteem
  • Mood swings
  • Poor organization skills or messy (clutters in the office or in the house)
  • Procrastination
  • Relationship problems
  • Substance abuse or addiction

These behaviors may be mild to severe and can vary with the situation or be present all of the time. Some adults with ADHD may be able to concentrate if they are interested in or excited about what they are doing. Others may have difficulty focusing under any circumstances. Some adults look for stimulation, but others avoid it. In addition, adults with ADHD can be withdrawn and antisocial, or they can be overly social, going from one relationship to the next.

School-Related Impairments Linked to Adult ADHD

Adults with ADHD may have:

  • Had a history of poorer educational performance and been underachievers
  • Had more frequent school disciplinary actions
  • Had to repeat a grade
  • Dropped out of school more often

Work-Related Impairments Linked to Adult ADHD

Adults with ADHD are more likely to:

  • Change employers frequently and perform poorly
  • Have less job satisfaction and fewer occupational achievements, independent of psychiatric status

Social-Related Impairments Linked to Adult ADHD

Adults with ADHD are more likely to:

  • Have a lower socioeconomic status
  • Have driving violations such as being cited for speeding, having their license suspended, and being involved in more crashes
  • Rate themselves and others as using poorer driving habits
  • Use illegal substances more frequently
  • Smoke cigarettes
  • Self-report psychological maladjustment more often

When ADHD enters the bedroom, distraction, wandering thoughts, and a lack of desire usually aren’t far behind. In fact, sexual boredom is one of the biggest complaints among ADHD couples, and a major reason behind their high divorce rate. Unfortunately, even when couples are sexually active, ADHD symptoms can interfere with emotional and sexual intimacy, leaving one or both partners feeling unconnected, alone, and sexually frustrated or unsatisfied.

Looking at ADHD & when intimacy just doesn’t jive.

Hurt feelings, confusion, and resentment can build and fester when one or both partners feel emotionally and/or sexually unsatisfied. If misinformation or misunderstanding is the main culprit, a marriage counselor or sex therapist can help the non-ADHD spouse understand how the disorder affects sexual desire and performance.

For instance, many ADHD partners are too hyperactive to relax and get in the mood. Instead of shutting out the world and focusing on their partner, they’re distracted by their racing thoughts. Others are distracted by loud music, even if it’s romantic. Instead of focusing on their partner, they may start singing along or talking about how much they loved the last concert.

How to Improve Sexual Intimacy

Provided there aren’t emotional distractions or barriers interfering with intimacy, it’s possible to overcome distractions that may prevent an ADHD spouse from being able to focus on, respond to, or enjoy sexual intimacy.

The following are some strategies for turning up the heat in your ADHD marriage or relationship.

  • Talk openly about what turns your ADHD spouse on — and off. If she’s super-sensitive to scented oils or lotions, finds music more distracting than romantic, or can’t stand your scratchy beard, get rid of it.
  • Be open to new experiences. ADHD adults love novelty, so don’t be afraid to introduce something new to ward off ADHD boredom. Make sure you’re both comfortable with it before trying anything. If your ADHD spouse isn’t comfortable with it, it’s likely to become yet another ADHD distraction.
  • Practice being in the moment. To help your hyperactive partner stay in the now, try doing yoga, tai chi, meditation, deep breathing exercises, or massage as a couple. Then move the relaxed togetherness into the bedroom.
  • Let go of libido-killers. When ADHD symptoms make your ADHD spouse unreliable, it may force you into assuming the role of parent. Once the child/parent pattern becomes the norm in a relationship, romance and sexuality between partners usually declines. If you and your partner are trapped in this pattern, work with a therapist to rebalance your relationship so you’re both equal partners.
  • Make a date. If conflicting schedules are preventing you and your partner from having fun together, playing together, or hooking up, make a date and put it on the calendar. Then commit to it.

Lasting Happiness and Love

While ADHD poses disadvantages in a relationship, it also has many advantages. Opposites often attract, so if you’re the steady, reliable, and dependable type who could use a jolt of spontaneity, impulsivity, novelty, and excitement, an ADHD spouse may be just what the doctor ordered. On the other hand, if you’re an ADHD adult who has trouble balancing his checkbook, matching his socks, or remembering to feed the dog, a non-ADHD spouse could be the gift from heaven you’ve been searching for.

While it may take some effort, it’s possible for an ADHD relationship to have a happy and permanent ending. An ADHD spouse needs to take responsibility for his disorder rather than use it as an excuse for his problems.

In addition, the non-ADHD spouse needs to remember that she’s married to someone who’s wired a little differently than most people. While an ADHD marriage may not always run like clockwork, it could be a lot more lively and fun.

Treatment for ADHD or ADD in adults:

  • Individual Therapy
  • ADD Coaching
  • Medication
  • ADHD/ADD centers
  • Neurofeedback Training for ADD/ADHD


“Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”

NIH National Institute of Mental Health

Part I ADHD Awareness Month


People with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. Although ADHD can’t be cured, it can be successfully managed and some symptoms may improve as the child ages.

Let’s take a look into these 2 developmental disorders starting with what ADHD is like in the USA.  For starters ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.    These symptoms include 2 main sections include inattention and or hyperactive/impulsive behavior.

The symptoms the child may show that could indicate ADHD if this has been the last 6 months or more:  The CDC presents that 6 of these symptoms or more of inattention for a child at 16 years old or less or at 17 years old to adult 5 or more signs and symptoms present.  This would be the following s/s for inattention:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted
  • Is often forgetful in daily activities.

For hyperactive or impulsive behavior same concept with the amount of s/s at the same age groups with inattention, which could be:

  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting his/her turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

Myths and Facts about ADD / ADHD in Adults

MYTH: ADD/ADHD is just a lack of willpower. Persons with ADD/ADHD focus well on things that interest them; they could focus on any other tasks if they really wanted to.

FACT: ADD/ADHD looks very much like a willpower problem, but it isn’t. It’s essentially a chemical problem in the management systems of the brain.

MYTH: Everybody has the symptoms of ADD/ADHD, and anyone with adequate intelligence can overcome these difficulties.

FACT: ADD/ADHD affects persons of all levels of intelligence. And although everyone sometimes has symptoms of ADD/ADHD, only those with chronic impairments from these symptoms warrant an ADD/ADHD diagnosis.

MYTH: Someone can’t have ADD/ADHD and also have depression, anxiety, or other psychiatric problems.

FACT: A person with ADD/ADHD is six times more likely to have another psychiatric or learning disorder than most other people. ADD/ADHD usually overlaps with other disorders.

MYTH: Unless you have been diagnosed with ADD/ADHD as a child, you can’t have it as an adult.

FACT: Many adults struggle all their lives with unrecognized ADD/ADHD impairments. They haven’t received help because they assumed that their chronic difficulties, like depression or anxiety, were caused by other impairments that did not respond to usual treatment.

Source: Dr. Thomas E. Brown, Attention Deficit Disorder: The Unfocused Mind in Children and Adults

It is understandable for parents to have concerns when their child is diagnosed with ADHD, especially about treatments. It is important for parents to remember that while ADHD can’t be cured, it can be successfully managed. There are many treatment options, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help you guide your child towards success. Remember, you are your child’s strongest advocate!

In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way.

Following are treatment options for ADHD:

  • Medications
  • Behavioral intervention strategies
  • Parent training
  • ADHD and school

Part 2 Tomorrow on Adult ADHD.





Atrial Fib with Rapid Ventricular Rate Month Awareness!

afibafib RVR


Atrial fibrillation, or AFib, is the most common type of arrhythmia.

A heart arrhythmia is an abnormal rate or rhythm in your heartbeat. This can mean your heartbeat is too slow, too fast, or has an irregular rhythm.

Most arrhythmias are harmless, and may not cause symptoms. Some types, however, can have serious consequences and require treatment. Dangerous arrhythmias may cause heart failure, stroke, or low blood flow that results in organ damage. Most people with arrhythmias, even serious ones with treatment, live normal and healthy lives.

Working of the heart:

To easily identify atrial fibrillation with RVR=Rapid Ventricular Rate, it is vital to understand the working of the heart. The atrium or atria (plural) is the upper chamber of the heart, bigger in size compared to the lower chambers known as the ventricles. The atria function by gathering blood as it flows into the heart and shrinking to forward the blood into the ventricles. At the very moment, the smaller ventricle must shrink to forward the blood to all parts of the body. This rhythm of blood flow creates a heart signature voice referred to as the Sinus rhythm. It is important that the sinus rhythm is synchronized so that the atrium does not send blood into the ventricle out of cue. To achieve this, an electric signal is generated to ensure the atrium contracts. When this signal short circuits (bypasses) the atrium, atrial fibrillation with RVR occurs, and the atrium is seen to vibrate just like jelly on a flat surface.

Atrial fib with RVR refers to atrial fibrillation with rapid ventricular rate. Usually the heart is like clockwork, the top (collecting) chambers beat then the bottom (main pumping) chambers sense this and also beat, and so on, in a nice regular fashion just like a clock ticking second after second. Usually the heart beats at about 60-80 beats per minute.

In atrial fibrillation the top chamber basically goes crazy often firing off over 400 beats per minute! Atrial fibrillation with RVR (Rapid Ventricular Response) is a heart condition caused by irregular electrical activity that results in irregular contractions of the 2 top heart chambers fibrillating. This means the heart (atriums), shakes with a rapid tremulous movement or makes fine irregular twitching movements, generally referred to as fibrillating causing little control in the heart output of blood by the heart but the lower chambers called the ventricles take over.

These bottom chambers don’t allow all those impulses through but it does let every second or third one through. This can give a heart rate of 100-180 beats per minute at rest, still too many beats, known as Afib with RVR, leading to symptoms and problems with heart function. Afib does not necessarily lead to Afib with RVR however, Afib can be rate controlled, sometimes naturally, sometimes using medications and sometimes requiring procedures as discussed below.

In most people with AFib although symptoms can sometimes be unpleasant it is generally not harmful as long as the afib is controlled, meaning the heart in the afib rhythm with the pulse under 100. The main concern is stroke, but that can be treated with the use of blood thinning medications in people at risk. In Afib with RVR, basically the heart is beating too fast. Of course palpitations are the most common symptom. Other symptoms of AFib with RVR may include dizziness, lack of energy, exercise intolerance and shortness of breath. If Afib with RVR goes on for too long then this may result in heart failure and of course worsening of existing heart failure. Control of the heart rate in patients with Afib with RVR often causes these symptoms to improve, again meaning the HR is under 100 with the heart rhythm in afib.

A major indication of atrial fibrillation with RVR is a very rapid heartbeat rate, although some patients are known to have the condition without showing symptoms. Atrial fibrillation with RVR may occur when cardiac muscle cells overcome their intrinsic pacemaker’s signals and fire rapidly differently from their normal pattern spreading the abnormal activity to the ventricles. The rapid heart rate can strain the heart, developing a situation referred to as Tachycardia (meaning a pulse greater than 100). Atrial fibrillation with RVR can be detected from the various symptoms though it is important to remember that some patients have experienced the condition without symptoms.

Symptoms:Some of the symptoms of this disease include heart palpitations (described as unnoticed skipped beats or skipped beats noticed from experienced dizziness or difficulty in breathing), shortness of breath when lying flat (orthopnea), shortness of breath (dyspnea after exertion) sudden onset of short breath during the night (also called paroxysmal nocturnal dyspnea) and gradual swelling of lower extremities. As a result of inadequate blood flow, some patients complain of light headedness and may feel like they are about to faint, a condition referred to as presyncope and may actually lose consciousness (syncope). Some patients experience respiratory distress that results in them appearing blue. A close examination of jugular veins usually reveals elevated pressure in some patients (jugular venous distention). When some patients are subjected to lung examinations, crackles and rales may be observed pointing to possible lung edema.

Importance of proper diagnosis:

A good diagnosis of the symptoms shown by patients is important to ascertain that the patient is suffering from atrial fibrillation with RVR.  This is because some forms or irregular and rapid heart rates, tachyarrhythmia, are dangerous and must be ruled out as they are life threatening – such as ventricular tachycardia. Some patients are usually placed on continuous cardio respiratory monitoring, but an electrocardiogram ECG is vital for correct diagnosis.

 How is it diagnosed?

 Simple, a typical 12 lead electrocardiogram (ECG). This test shows cardiac rhythms which atrial fibrillation is. Rhythms are made up of types of waves that the ECG shows which are P waves, QRS waves, T waves and U waves.

The QRS complexes should be narrow, to signify that they are being initiated by normal conduction of atrial electrical activity through the Intra-ventricular conduction system, or heart conduction system. Wide QRS complexes could point to ventricular tachycardia, although wide complexes may also be an indication of disease processes in the Intra-ventricular conduction system. The R-R internal will also likely be irregular. Meaning measuring from each R section of the QRS rhythm. It is also important to find out if there are triggering causes for the tachycardia which include dehydration, Hypovolemia – a decrease in blood volume, and more specifically decrease in blood plasma volume. You can go ahead to eliminate Acute coronary syndrome – which refers to any diseases that are directly attributed to the obstruction of coronary arteries.


The cornerstones of atrial fibrillation (AF) management are rate control and anticoagulation  and rhythm control for those symptomatically limited by AF.  The clinical decision to use a rhythm-control or rate-control strategy requires an integrated consideration of several factors, including degree of symptoms, likelihood of successful cardioversion, presence of comorbidities, and candidacy for AF ablation (eg, catheter-based pulmonary vein electric isolation or surgical ablation.)

A Shock

This is known as cardioversion and is used typically either when an immediate result is required or used when the Afib is of relatively recent onset or only intermittent, and so has more chance of staying in normal rhythm. In cardioversion a small shock is given using defibrillation pads in sync mode. It is done under light anesthesia therefore it doesn’t hurt; pt is sedated if allowable. The Afib may or may not return however.  Highier odds the afibrillation could turn back to normal sinus rhythm if this afibrillation is newly diagnosed not chronic.

Rate Control Drugs

The biggest problem in Afib with RVR is too fast a heart rate. In a rhythm control strategy we use drugs such as beta-blockers to slow the heart rate down. These drugs typically will leave the patient in AF. For many people with AF it turns out that a rate control strategy is preferred as it is considered less risky than the rhythm control drugs used to get rid of the AF while being just as effective. In Afib with RVR rate control drugs can often slow the heart rate down fairly quickly and improve symptoms.

In the ER with newly diagnosed with pt stable the MD will order medication to decrease the rate

Rhythm Control Drugs

These medications are generally more powerful than the rate control drugs and attempt to convert the Afib back in to a normal rhythm. They are often given after a shock treatment to try and help the heart stay in normal rhythm. These drugs are also commonly used in hospitalized Afib with RVR patients. The problem with these drugs is that they may have side effects and associated risks. Many patients simply cannot tolerate Afib even if the rate is controlled and therefore require rhythm control drugs. They may be safe and effective however if used in selected patients. In cases of Afib with RVR these medications may need to be used if patients cannot tolerate other rate control medications.

Ablation Procedures

Ablation is a minimally invasive procedures typically done through the groin. They are typically used in patients that have tried, or cannot tolerate medicines for control of AFib. Ablation is typically not used as an emergency treatment of Afib with RVR, rather it is used for stable patients in AF, or those with intermittent AFib that wish to remain in normal rhythm. In patients that have had persistent Afib for a long time these procedures are not likely to be successful in the long term.


This is typically the last throw of the dice for AF control. In some patients, drugs can either not control the rate in AFib with RVR, or the drugs can simply not be tolerated. In these patients who have no other choice, and in whom it is determined the Afib is causing harmful effects, a procedure called AV node ablation and pacemaker is done. In a relatively minor procedure, a small burn is made to the connection that connects the top and bottom chambers of the heart. A pacemaker is then inserted. This prevents Afib with RVR as although the top chambers continue to fire at a fast rate, the pacemaker now controls the bottom chamber, in a nice regular way. The downside of course is that now although the patient cannot have Afib with RVR, they have a pacemaker rather than the SA Node, our natural pacemaker in the heart in the R upper atrium.

Acute afib RVR patients are more likely to be converted to Normal Sinus Rhythm (the best rhythm you could be in) as opposed to patients with chronic afib. There are complete resolutions for both kind of afib but atrial fibrillation in RVR the heart can handle for only so long and remembering the engine of our body is the heart so take good care of it for if you don’t it could allow you to die.





“People who are physically active, eat a healthy diet, do not use tobacco, and practice other healthy behaviours reduce their risk for chronic diseases and have a much reduced rate of disability compared to others who don’t do this lifestyle.”

British Columbia Ministry of Health

Aging in style or just aging looking like your suppose to, you make the choice!


I am enjoying my adulthood journey and wish I could say the same for many of our aging population. What I am observing as a RN, daughter and friend I must say it is a concern to me…why do many people of aging want to stay home in on talking about their illness (s) and making it their main topic of conversation? I can understand when a crisis happens, there is a new diagnosis that is heavy on their mind and that there stages they go through (shock, grieving, angry, bargaining, depression and acceptance) but I am not talking about this. I am talking more about the need to focus on the aging process where some look at it as a loss and a ‘giving up’ instead of looking at it for what it is… a time of a new stage in life from 40 where they challenge it or fight the struggles of health.  The aging process of mind and physical body goes through changes that can offer freedom, curiousity, and enjoyment. Let me give you some examples.

A family member of mine is in the last stage (I know I am 30 years of caring geriatrics down to 18 year olds and I have an idea how many live, some healthy with going about each day with a form of a work out or others closed in a box in their own world and do nothing but sit home.  There are conditions that slow us down but don’t cripple us  and having a condition that isn’t curable many can be kept under control.  Though many like my family member give in or give up to the conditions she has besides set in her ways, set to no change, not paying attention to what they ate or stop exercise and the amount they eat. By doing this behavior what develops is weight gain and the signs started showing up of further health conditions like obesity, adult diabetes II (occurs 45 and up roughly), cardiac disease that probably would have never developed if the individual balanced rest, a form of light exercise and good diet eating.  On top of that, from the immobility of sitting in the house or wherever you may sit all day gives you also sedentary lifestyle=less tone to the muscles with less muscle and more fat and stiffening of the muscle and joints that increases the risk of pulling a muscle or back which did to my family member, at first. Now over 6 years uses a cane and can barely walk with sciatica damage and the MRI and CatScan recently done only supposedly shows arthritis.

Prevent this people and you can!  How? Only just through a routine of balancing rest, exercise program (intense or slight work out = only 15 minutes a day), and good healthy dieting and high probability you will live longer with a better healthy tone body.  The KEY to obtaining this is start YOUNG and you will get into this as a routine and it will feel like it’s a regular part of your life with you wanting to do it but if your elderly you can still do it.  It will be harder getting older for some but go about it with your primrary MD’s approval with reviewing what is ok for a daily 15 minute exercise with proper dieting balancing this with rest. When he have a chance to correct obesity and prevent disease we should grab the opportunity before it is too late and unbearable to exercise, get out of the house, and now you sit in the house with few nearby friends or family to come by and visit.  Like many other families in the world going through this that ill one limits the places they can go, limits their independence (they have to be driven to long distances 30 minutes away or further, have to do there shopping etc…).  Where when they had there independence with having conversations with them other than there condition made you more out to look forward to visiting them or even staying on the phone longer.  Another example could be having a long term friend or sister you hung with for decades parting and gossiping and eating out and shopping together now moves into adulthood married with children.  Than this sister depends on you for babysitting frequently, driving or picking the kids up frequently from school events, gossips about how bad the marriage is for 8 years now.  Like anything else negativism all the time seen and heard you don’t want to be around.  It is unfortunate but true.  You on the other side feel obligated to do so for all the years of good life you had with that person but life now could be better in the end if that family person doesn’t put themselves in that situation but it doesn’t always work that way.  So make your life better and don’t but yourself in that situation.  I know someone who very much tryied to do so but it got so unbearable they hadn’t talk for 3 yrs or so and now are but there is a distance between the sisters.  One way of reaching a point in life to be able to handle raising children, work and be married is through good diet (treats now and than), good exercise a must, and balance with good rest; doesn’t always work that way with work but I try to make up for it.

My family member by diet and exercise could have helped the situation but now it is very unlikely to make a 180 to turn around and lives a hard life with getting around.  To have prevented this possibly one-making good healthy diet decisions and don’t eat after 5pm or 6pm.  Don’t have a dinner 9pm at night; or usually big meals after 6pm and make smaller meals.

I was very patient when I learned about the family member making life changes 6 years ago which was no progress in increasing activity and eating healthy.  Where my family member couldn’t even perform a lot of activities of daily living on her own and realizing that family member accepted to living that way and her being drawn in to live that way where it’s like a addition now to me (a lot of responsibility but over yrs it does play a lot of responsibility and stress to the me and my brothers).  This can definitely end your life sooner so it is up to you to change your eating habits and doing some exercise routinely. As a daughter and a friend, it was my job to help that loved individual go through this transition and give the needed support to ease all the changes that the family member would have to go through.

So, here’s his story now. That member is less than 84 years old and has had this condition for several years, continues to make this health issue the topic of conversation to me, family members, and friends even when things are going really well. The fact is, this condition for getting close to 10 years, my family member, has chosen to play the ‘poor me scenario’ at times it appears to come across as. The doctor and myself as a RN 30 years has provided excellent information and several resources to help with coping.  In only took me 6 years with some family siblings to help have her agree it’s time to move out of the house I grew up in since 1967.  No one else lives in that house.

It is taking a toll on my psychic energy. In other words, it sucks the life right out of me and, after visiting, I am tired after 14 hours working and so ready to take a nap.

I see this with other friends going through a similar situation with some family members also. They talk about their arthritic aches and pains plus stiffness in their joints as much as they do about the changes in the weather. These are chronic conditions, meaning they will experience this from time to time, and talking about it obsessively won’t change a thing.

At what point do people decide that the aging process means they need to constantly talk about their health issues? At what point do they stop engaging in healthier topics of conversation? What are the reasons for this shift in how they converse with people and, more importantly, do they even realize how depressing this whole routine is?

Again being a RN around geriatrics I understand.  One reason may actually be major depression (also known as clinical depression) , which is a medical illness. It is a chemical imbalance in the brain and can appear in people regardless of age, race or economic status. The illness can appear after a triggering event or for no apparent reason at all or simple normal with being alone by yourself (possible spouse deceased, friends moving if not dying off as age progresses) but when will this stop?  At this point I highly doubt it and for me writing with some exercise keeping you busy in work and a good diet and even a love life all help out.


Look for signs of:

  • Constant complaints of aches and pains (back, stomach, arms, legs, head, chest) , fatigue, slowed movements and speech, loss of appetite, inability to sleep, weight increase or decrease, blurred vision, dizziness, heart racing, anxiety.
    •An overall sadness or apathy, withdrawn; unable to find pleasure in anything or unable to have the need to get out to family gatherings or go to church anymore like previously it was considered a regular routine of that person’s life. •Also irritability, mood swings or constant complaining; nothing seems to make the person happy.
    •Talk of worthlessness, not being needed anymore, excessive and unwarranted guilt.
    •Frequent doctor visits without relief in symptoms; all tests come out negative.
  • Another reason is ‘doing as others do’. Meaning they mimic what other elders are doing. Again if that is what they see and hear from their associates, there is a strong chance they may get caught up in the same negative behavior. •Alcoholism can mask an underlying depression.
  • Another reason is the lack of stimulation, which will give them other things to talk about. Many times, elders find themselves alone with infrequent visitation from family and friends. They concentrate on familiar things like illnesses, chronic aches and pains, and the medications they take which become their major thing to talk about.

I, too, have minor health issues, however I chose to acknowledge that ‘it is what it is’. I have been dealt this hand and therefore I will do what I can to not let it slow me down. I look at the other side of the coin or at that ½ glass of water where it could be a lot worse.  It can be looked at I have the worst condition and play “feel sorry for me scenario” not even realizing it since it is talked about all the time or like I look at life there are so many worse of then me with disease, no home, no family, no friends and just surviving possibly getting a meal each day, if that.  Than the other side of looking at it positive is it could be worse and do the best you can.   As I said, I am an observer of people partly because I am an RN and it’s part of my job. I have made note that some of those individuals who are really struggling with major health issues overall hardly complain at all. They keep a positive attitude and in doing so they don’t let their condition stop them from enjoying life.  They don’t start a negative domino effect that just keeps dropping on top of another till it crashes them and unfortunately when this  continues to have a life spreading to others with that effect you turn them away.

Like everyone else we all have our headaches and on high probability in adulthood health issues with losses and aches & pains.  You have to deal with them in a positive note.  Meaning don’t blame the world or someone else for your health situation unless its real and lack of moving around (going out) even 10 minutes exercise a day or 2 to 3 times a week one hour exercise for elderly (just simply walking) with good dieting and rest will take you along way.  Going the opposite way, being negative and complaining of every ache with staying in the house only, gives you a shorter life and high odds a unhappy and lonely life.  Keeping a positive attitude, you may also find things that attract you which will keep you busier in life and people benefit from being around a cheerful positive person that attracts them in wanting to see you more.

I personally am not to far away from being elderly in about 20 years, I hope to stir the Pagan (polytheistic or open minded) community to take notice of how they choose to age. Are we aging with grace or are we just aging? Talk to the God and Goddess for help in modifying your way of thinking so you can handle life’s little ups and down. If you have family and / or friends who are displaying this type of behavior, show empathy and love by helping them comprehend the negative effects that persist when they chose to concentrate on their health issues in a pessimistic way. Sometimes it becomes a habit and they don’t even realize how often they even talk about it.

Behaviors can be changed, so make up your mind to age with GRACE and not just age.