About Me

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I was employed at Cozen O'Connor, an international law firm. I worked at the largest office in Philadelphia when I had my stroke on April 8, 2009, in the middle of the night. It took me a year to realize I could never go back there. It also took that long to realize I was disabled. I don't embrace the stroke -- not now, not ever -- but I accept it because I have two options: live with the stroke or... well, you know the alternative.

Apr 13, 2014

Beware, Fat People! A Stroke Might Be A-Comin'!

People are so touchy now-a-days. You have to say things “PC”, aka politically correct. You say the wrong word to describe them--fat, stupid, lazy, even if that description matches, and bingo! They won't talk to you, sometimes maybe never again. But the difference between me and them is now, I don't care. And as a result, some people don't like me. With the stroke, I have no filters—altogether.

It's a dichotomy, I realize now. A long time ago, when I was little, I did mind if anybody called me chubby, which I was, until about seventh grade when I got self-conscious, right on schedule. But “PC,” the expression, wasn't in yet. Clothes used to come in regular and chubby sizes. I took a chubby size all the way through elementary school. I didn't know any different because I had a fat brood—my immediate family, uncles, aunts, cousins, fat people whatever way I turned. The truth is, I loved to eat because I didn't know any better. Eating a lot used to equate to love. But what the hell?

The fat that I once had doesn't have any bearing on the stroke I now have, or does it? But if you're overweight, morbidly obese, chubby, pleasantly plump—call it what you want—you may be in trouble.

The National Stroke Association says that obesity can put stress on the whole circulatory system. And a recent Harvard University study found that you could cut your stroke risk by
30 percent by eating five daily servings of fruits and vegetables instead of fries, chips, alcohol, and soda. Citrus fruits, broccoli, and cauliflower are noted as particularly helpful. It may be their higher concentrations of potassium, folic acid, and fiber are the clues.

And an escalating number of children are obese. That's why there are cases of stroke in younger individuals, too—even babies (see my articles in my blog, http://stroketales.blogspot.com/2012_12_09_archive.html and http://stroketales.blogspot.com/2013_04_06_archive.html).

The American Heart Association (AHA) “recommends at least 60 minutes of physical activity a day for kids.” The AHA also “recommends that adults get at least 150 minutes of moderate or 75 minutes of vigorous physical activity a week.” If you're fat, you can make time. You just don't want to. You're a creature of the fat habit.

Michelle Obama gets serious when it comes to fat, er, fit kids. That is her mission. http://www.theblaze.com/stories/2014/04/05/students-fed-up-with-michelle-obamas-school-lunch-overhaul-menu-item-snapshots-spell-out-why/. Of course, they object. They would rather stuff themselves with fatty foods rather than eat healthy. I don't like to blame the parents, but who else can I blame? Instilling good eating habits is tough when you're passing Mickey D's and it's easier than packing lunch. Really? That's bullshit.

Individuals who are obese have a greater chance of succumbing to sleep disordered breathing, known as sleep apnea. And those with sleep apnea have a greater risk of stroke.

Ok. Need more evidence? A new study by researchers at Columbia University says that people with abdominal obesity are at higher risk of ischemic stroke, the most usual kind of stroke, caused by blockage of a blood vessel in the brain.

Most of the weight loss articles mention BMI, or body mass index. I'll tell you a simple way to tell if you're overweight if you haven't seen the fat already or you need further proof. The National Institute for Health, aka NIH, has a meter located at http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. When you give your height in feet and inches and your weight in pounds to the NIH, it gives you guidelines for where you are in the BMI range:
  • Underweight = <18 .5="" p="">
  • Normal weight = 18.5–24.9
  • Overweight = 25–29.9
  • Obesity = BMI of 30 or greater
So I did it. I found out, thinking I was normal weight, that I fall into the normal weight range, just by a smidgeon. I tried another scale, this one from the Centers for Disease Control and Prevention, http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/results_overweight.html. Same result. I was shocked. Just a smidgeon? Seriously?

And one more thing. Being overweight and having a stroke is just too much at times. When I gorge, I watch myself over the next few days. It's like you can tell you've gained weight without a scale to remind you. It's the extra pounds that add to the baggage you have to lug around in the first place.

Did somebody raise the bar? I could fool those old-time types on the Boardwalk and at county fairs that could guess my weight and give me a prize if they were crazy off the mark. I think that old saying is true, for me at least. "You carry your weight well."

Apr 4, 2014

Empathy and Sympathy: There's a Difference, aka Nosey Paid Off

I have a confession to make. I'm nosey, probably because I used to be a reporter. I listen in on everything—a cell phone call, restaurant chatter, a conversation between folks sitting on a bench. Then my imagination takes over and I think I'm a reporter again, creating all sorts of scenarios for why the talk happened in the first place. That process keeps my mind sharp, or as sharp as it can be for someone with a brain injury from my stroke.

One time, I was listening in a restaurant to two college students having coffee in the next booth, discussing the project that they were tasked to accomplish: the difference between empathy and sympathy.

“I need an “A” on this project,” the one girl said, “in order to appease my parents. They said if a get all "A's," they would buy me a car.”

“I should get an 'A,' too, in order to pass this course,” the other one said.

I couldn't help it, now that I have no filters of any kind since my stroke. I got the attention of one of the girls and said, “Empathy and sympathy? I could help you with that.”

I, who was having a grilled cheese bagel and tea, and my friend, who was eating a Reuben sandwich--corned beef, swiss cheese, cole slaw, and Russian dressing—and a Coke, slid over to make room for the girls who now came to join us, bringing their coffee in tow.

I thought they were desperate to know because one girl had a car at stake and the other would be in deep doo-doo if she failed the course. And they were just too young to know the difference. I proceeded to tell them, and they had their paper and pens ready to take notes.

“Empathy is comprehending what others are feeling because you were in their shoes yourself or have the ability to put yourself in their shoes. Sympathy is providing comfort when some life-changing event occurs to others.

“Empathy and sympathy are both feelings. You can send somebody a sympathy card and forget it. It's just an act of kindness, often impersonal. But with empathy, you get right to the heart of the matter, with thoughts of experiencing the situation yourself.”

And then, I drew some pictures.



Even though they were years younger than me, around 50 years or so, they were smart enough to comprehend.

One of the girls, who was promised a car if she achieved all "A's" asked, "So empathy is harder than sympathy."

"That's right," I replied. "Empathy is harder, and it's more helpful but less common; sympathy is less helpful but more common."

I told them a story of what happened to me in the hospital when I had my stroke.

"Somebody who will remain nameless sent me a sympathy card that said, 'Sorry to hear of your loss.' I felt like I had died. But I didn't. She should have sent a 'get well' or 'thinking of you' card. So sympathy cards should be carefully selected, for mainly death in the family or friendship circle. Sending a sympathy card to a stroke survivor is wrong, mainly because they survived."

I was starting to lose their attention with my story, true though it was. I went on with more detail and their pens were poised once again.

"Empathy can apply to lots more things than death, like getting caught in the rain without an umbrella when you're going to someplace important, losing lots of weight, or changing a tire on a busy highway. If you experienced any of those things, then you know what you're talking about when you say, 'I know how you feel.' And empathy can apply to good things, too."

The girl who had to get an "A" in the project yawned loudly. And then she yawned again. The "car" girl wasn't far behind, but she stifled the yawn out of respect for me. 

We had an appointment coming up and had to leave, and the girls stood to let us by and soon took their new seats once again.

"Thank you," the girls said in unison.

"It was my pleasure," I said. And it was. I was the professor again and I felt great. On the way out, I said, "I'm glad I had the opportunity to teach those girls."

My friend said, "I know how you feel. I'm happy for you." She was a professor, too.

Mar 16, 2014

Different Cultures, Different Mindsets, aka Are They Behind the Times?

I wrote a post on mammograms that started off humorously, I think and still do, with this picture (http://stroketales.blogspot.com/2012_09_04_archive.html), that said, "Men basically have two things to worry about: erectile dysfunction (yes, ED has an awareness platform, too) and the prospect of prostrate cancer. Big deal. But most men don't know what it takes to be a woman because they've never walked our mile." I then went on to elaborate that "our mile" consists of elusive tampons, bipolar-ish pregnancy hormones, and itchy, non-tested make-up. I thought it was funny, sarcastic humor at its best, at least the best I can do. 

I have pissed off two countries. But seriously, the reality is, both sexes have problems, and often the same, like money issues or additional health problems. That post set off a firestorm of direct hits on Facebook and emails that I got to thinking, it must be a cultural thing.

The overwhelming majority of responses came either from Great Britain or Australia which have a shared language, accent (at least, to the undiscerning, American ear), and legal system based on common law. They also share a monarch--Queen Elizabeth II. It all made sense, now that I thought about it. Here's a thought: If all the English and Australian people were suddenly beamed up, Star Trek style, to America (which isn't possible because America, as far as I know, has no beam-up ability), the overwhelming majority of them would join the Republican party, or go the Tea Party route. (Again, another piece of Hoffman humor. Ha ha? I don't think the Brits and Aussies are laughing at my thought).

Anyway, there's no doubt about it that there are cultural differences between Americans and Brits/Aussies, like mentioning tampons in the post was a no-no, or diaphragms? Good lord! The fact is, tampons and diaphragms are the real deal, but reality hasn't set in yet with most Brits and Aussies, maybe never. That's how I see it.

Those responses to my post got me thinking further. Probably overall, there may be  some questions for more on we do things here in America, like how we have stupid, reality television shows about the broads (I give them that "title" purposely) in major cities (like Real Housewives of 'you-fill-in-the-blank-and-who-gives-a-shit-anyway), like why we blame Obama for the government's healthcare website when bugs come with every website launch, why we drink supposedly healthy, bottled water in the billions annually, yet we don't give a damn about what processed, fast foods we consume. And more. Lots more.

So to Brits and Aussies, though I stand by my post, I apologize if it offended you. To all those in the same, aforementioned group who "liked" it (a Facebook term) and got a chuckle out of it, congratulations on your being thick-skinned, enlightened, and intelligent. 

Uh, here we go again?

Mar 3, 2014

Distractions, Disablements, Displeasers, aka Aah! There Are Others, Too!

I have my contact info in my blog. So I was not surprised that I recently received an email from a lady named Grace, and this is what she said:

Hi - I like your blog, but it's hard to read because of the "ink stain" (the wallpaper of your blog). As a stroke survivor, any visual distraction can be hard to deal with.

Thank you, Grace, for that comment. In an effort to satisfy all my readers, I changed the wallpaper.

Here is what my blog looked like before:

Here is my blog now:

I chose the first wallpaper because it made me feel like I was a columnist for the newspaper again. I chose the latter wallpaper because of Grace.

But that email gave me an idea. How many other people didn't read my blog because of the ink stain? As Grace put it, "any visual distraction can be hard to deal with."

I don't have visual distractions in that way, from wallpaper with ink stains, but right after my stroke, my friend took me to "Avatar," the 3-D movie. When we sat down, I put on the 3-D glasses that the theater provided and the movie began, but I immediately had a headache and dizziness, and took off the 3-D glasses. My headache and dizziness stopped. After about 10 minutes, I put the glasses on again, testing myself, and the headache and dizziness resumed.

I sat for over an hour putting the glasses on--and off--at first, thinking it was an anomaly, but I couldn't chalk it up to a mere coincidence. The headache and dizziness always returned when I watched the film with the glasses. Eventually, I closed my eyes for the rest of the lengthy movie and listened, but I missed much in the high-action film. But at least, the headache and dizziness didn't return. The stroke, somehow, was the reason, disabling indeed.

I received another email recently that said: "I have no filters on what I'm saying. I always say something hurtful." The email was signed Anonymous and I won't reveal the address, but it looked ordinary enough,
like joe@yahoo.com. (Sorry, "joe," if you're reading this post). So back to  Anonymous. I have that problem, too. If people brush too close to me in a store, I'll say, "Ex-CUSE ME!" Anyway, it's very displeasing to me, and to the person, if they even heard me.

Are stroke survivors having these problems? The question is rhetorical. Of course they are, about 800,000 a year worldwide. They may be not having the exact stroke "side effects" I just mentioned, depending on the extent of brain damage and where the damage occurred, but trust me. Hardly anyone gets a stroke and comes away unscathed. So Grace and Anonymous, and to all the other stroke survivors out there, onward and upward. Like I say in the description to my blog, I have two options: live with the stroke or... well, you know the alternative.

Feb 23, 2014

Fractured Bones and a Doctor with an Attitude

I broke my big toe on a cutting board that had fallen from a pile of stuff. Please. Don't ask. Imagine whatever you'd like. 

That was in October 2013 and I quit going to the gym, and naturally, what I had gained gym-wise was depleting rapidly. In November, I went to rehab in Pittsburgh, where I was visiting my son, and the therapist phoned the rehab doctor, known as a physiatrist (I always love to say physiatrist because people always think, as a result of my  stroke,  I'm mispronouncing psychiatrist and they think I'm going to a shrink--sorry to disappoint), who said that 2 or 3 weeks in the rehab in-patient facility (rehab 4 to 5 hours every day of the week) might prove to be not such a bad thing. He was serious, and he said to come back Monday for a solution. I mean, I couldn't just check in to a hospital for rehab without his help, but ironically, something happened to make it so.

In December, still visiting Pittsburgh,

my cousin came to visit for a week. Do you know what the Ancients said about visits? Visits are like bad fish. Stay for more than 3 days and they'll both end up stinking. I don't about that analogy, but her stay was hectic, with her 10 steps ahead wherever we went. I tried to pretend I could keep up with her--it made me feel normal, but it was pointless. She was always in a hurry, like she was having a race with her bucket list.

She left when the week was up, and I was invited to my son's house to chill out and have chicken soup with
non-gluten matzah balls. You'd think non-gluten matzoh balls would be a set up for a joke, but it's not.
Nothing is funny here, both before the non-gluten matzah balls or after. By the way, I couldn't tell the difference between non-gluten and gluten. All matzah balls taste the same. The thing that matters is the weight of the matzah balls. My ex-mother-in-law's matzah balls were like tiny bits of mortar, hard and dangerous if they were airborne, but I digress.

I traveled up my son's path with him right behind me. And then I caught my foot on the lip of the step and
I fell backward. Fortunately, my son was there to catch me, but not before I skinned my knee and my elbow, and telling my son, once again, that I was incapable of grace. I went into his house, had the soup, and went back to my apartment. 

Here's where the strange part comes in. In summary, I went into his house and an hour and a half later, walked back to the parked car that was across the street. I walked up the outside 4 steps to my apartment, up 4 steps again inside to get to the elevator, and down a long hallway--maybe a hundred feet--to enter the apartment. I went to the bathroom, brushed my teeth, and went to bed. I got up in the morning (here's it is--the mind-boggling part), went to the bathroom, and as I stood up, my stroke-affected leg collapsed like it was out of power. Fortunately, I didn't hit my head as I careened into the bathtub.

So there I was, on the bathroom floor, but luckily, I had Life Alert. You know, "I've fallen and I can't get up" commercials? So I pressed the Life Alert button and shortly, two paramedics were standing in my bathroom doorway. The maintenance man let them in.

One paramedic said, as he helped me to my feet, "Your choice. You can go to the hospital or not. You're not hurt, as far as I can tell. But you never know."
Hey, that's my line.

I thought about it. My foot just collapsed. Was I tired from the hectic-cousin visit? Or maybe there was something else wrong. Or maybe it was the combination of both. If I was a betting gal, I'd go with the latter. And I didn't have an option.

So I took a ride in the ambulance and went to the closest hospital. They kept me overnight, what they called "observation mode." When they took an x-ray of my ankle and upwards, the orthopedic surgeon said that nothing was broken, but my foot ballooned to thrice its size, bright red, and swollen and when the doctor pushed it, his fingerprint impressions remained.

"Maybe I broke my toe again. I mean, there has to be some reason that I walked on it yesterday and this morning, my foot collapsed," I intentionally whined. (Everybody hates a whiner).

The doctor said, "We'll x-ray you toes," in a snarly fashion, like he didn't like me telling him his business. 

"Too bad," I said to myself. Most doctors in the universe are like that, at least in my experience.

The x-ray happened a short while later, but at this point, I couldn't even put any pressure on my foot. The doctor came in with the results in a half hour.

"You fractured the second and third metatarsals." He looked down at the floor. He couldn't get over the fact that I was right. "We're going to transfer you to a different hospital that has more physical therapists than here," the snooty doctor said, who still had an attitude. He was sneering, or maybe that was my imagination.

So I went to a different hospital and just as the physiatrist said, I got rehab 7 days for around 30 hours a week. I stayed there for 3 weeks and then it was time to go back to the apartment. Even though I enjoyed the therapy, I had enough.

My fractures healed to the day the doctor predicted, about 4 weeks later. And I was happy that I had instructed the doctor to do what made sense. Sometimes doctors and other health professionals don't listen to the patient, as it was in my case. Hell. I wrote a book about that very thing.

Not to miss an opportunity:
My book, "The Tales of a Stroke Patient," is available online everywhere.

from the publisher, http://bookstore.xlibris.com/Products/SKU-0115053049/The-Tales-of-a-Stroke-Patient.aspx,
or from Amazon,  http://www.amazon.com/The-Tales-Stroke-Patient-ebook/dp/B009J9QC64/ref=sr_1_1?ie=UTF8&qid=1373898600&sr=8-1&keywords=tales+stroke+patient,
or from Barnes & Noble, http://www.barnesandnoble.com/w/the-tales-of-a-stroke-patient-joyce-hoffman/1113052852?ean=9781479712496.
Don’t have a credit card? Message me at hcwriter@gmail.com or Facebook to see how you can get a copy!

Feb 8, 2014

My Personal Evolution, aka As It Turns Out, She's Not All That

Lists are a way to keep track of the things you should--or should not--be doing or have done. When you're done with the list, presumably you're finished with all the things listed on the list. But are you really? The lists are usually in 5s or 10s, convenient, familiar numbers to use. Take a look at some samples:

5 Foods That You Should Never Eat (I still eat 3 out of 5)
5 Stages of Grief for Chiefs Fans (They were doing so great for a while)
5 Stages of the Sleep Process (If you think of the 5 stages, you won't go to sleep)
5 Stocks With Big Insider Buying (Wall Street sucks)
5 Books to Help You Reach Your Goals for 2014 (Reach your goals? Really?)   
5 Signs You May Have Pre-diabetes (Or maybe the actual diabetes)
5 Best Films Oscars Nominations (They usually come in 5s)
The Top 10 Lists of David Letterman (Er, that is, David Letterman's writers)
Best 10 Movies of Matthew McConaughey (It's the dimples...anything he's in, I like)
5 Years After, 10 Things to Remember (I could think of a lot of things if this article was called, "10 Years After, 5 Things to Remember")

Lists are completely and purposely definitive. But are there only 5 or 10? How about if there's so much more? Take Elizabeth Kubler-Ross, for example. She was the author of the 1969 legendary bestseller, On Death and Dying, and a psychiatrist, who died in 2004. I wonder if she took her own advice about death and followed all the stages of grief: denial, anger, bargaining, depression, and acceptance. In one article, she said that she was ready for death after suffering multiple strokes. But was she really? Known as the Kubler-Ross model, did she skip the first 4 stages and go directly to acceptance? I have my doubts.

Yale University conducted a study of bereaved individuals between 2000 and 2003, based on the Kubler-Ross model, and concluded from their findings that half were consistent with the five-stage theory and others were conflicing with the model. P.K. Maciejewski said in 2007, in the Journal of the American Medical Association (JAMA), several letters were also written and published in JAMA, criticizing this finding and belittling "the stage" concept because, for one thing, the Kübler-Ross model didn't evaluate the support--friends and family--aspect.

More recently, Megan Devine, the author of "Everything is Not Okay," and a contributor to the Huffington Post, wrote "The 5 Stages of Grief and Other Lies That Don't Help Anyone" in December 2013. In the article, Devine says of Kubler-Ross model, "The griever is expected to move through a series of clearly delineated stages, eventually arriving at 'acceptance,' at which time their 'grief work' is complete...and if you don't progress correctly, you are failing at grief. You must move through these stages completely, or you will never heal.This is a lie."

Devine goes on to say, "[Even] Elisabeth Kubler-Ross wrote that she regretted writing the stages the way that she did [in retrospect], that people mistook them as being both linear and universal. Based on what she observed while working with patients given terminal diagnoses, [Dr.] Ross identified five common experiences, not five required experiences."

Ruth Konigsberg, the author of "The Truth About Grief: The Myth of its Five Stages," confirms Devine in saying, "The Kübler-Ross theory has never been validated by one single study. But it certainly seems time to move beyond our current habit of using untested theories to create unnecessarily lengthy and agonizing models for loss, ones that I believe have created more fear of and anxiety about the experience.” Konigsberg also says how tthe Kübler-Ross five stages mistakenly "show a hopeless road, making people think that they must grieve for the rest of their lives." Konigsberg stated that “loss is forever, but acute grief is not, a distinction that frequently gets blurred.”

You're reading about death, but actually this advice from Devine and Konigsberg, in my opinion, applies to anyone or anything you're mourning, i.e. death of a marriage, of a job, of a pet, of a child or spouse, of an illness. I don't know what's going on in the head of another, so I'll only talk from my perspective. There is no cookie cutter pattern for me, and most likely others, as it relates to stroke. Each stroke survivor grieving the loss of impaired body function, just as snowflakes (presumably), is different.

We are constantly evolving, from one day to the next. Grief has its own timeline, custom to fit you. The stages don't go in order either. I still, five years later, have not accepted my condition for any significant length of time. The shortest stage for me was bargaining because I already had the stroke. Bargaining in duration was not an option. The longest stage for me was anger.

I have a theory. The better your life is right before the stroke, the more you will resist positivity after the stroke. Distractions, like going to the movies or going out to dinner help, but they are only temporary. When I get into bed after the chilly, bleak day is done, I don't like how my affected foot is just lying there outside the cover, or I have to pee two hours later and just can't "run" to the  bathroom. Stuff like that.

And I have more stages than the five in the Kubler-Ross model:

I got "guilt," a 6th stage, when after I had a stroke at 4am, my manager was left in a lurch without me. Not so much anymore, but traces of it surface now and again.

I got "ambivalence," a 7th stage, because I didn't know where I was, emotionally speaking. Sometimes, for about a year when I first had my stroke, anger would be followed by depression going back to anger in rapid succession, and sometimes, both anger and depression would come simultaneously. Or I'd lay there in limbo, trying to decide on my emotion.

And finally, I get "frustration," an 8th stage, even now, when the people looking at me and on the phone don't understand me. Sometimes, the ones in person put their heads at an angle and squinch up their faces in anticipation of not understanding me. The people on the phone probably do the same as well. I'm intelligible, but when I get tired, I have to be careful that I'm not slurring my words. Like I said, I'm evolving.

 You don't have to buy my book to know that nobody, except the evil doers of horrendous deeds like Hitler and Osama bin Laden, deserves a stroke. Nobody.

Jan 25, 2014

Tra-la-la-la-la: Music Therapy Solves So Many Problems

When I was 12, my parents bought me a transistor radio for my birthday--no headphone output and only AM. That was good enough because I didn't know any better. I listened to broadcasts of WIBG and rock 'n roll aficianado Hy Lit before school, and the same channel again in the late afternoon after I got home until bedtime. I used to joke that the transistor radio was surgically attached to my ear. My parents, who were Tommy Dorsey fans from the 40s, couldn't understand the words the maniacs (their words, not mine) were
singing. But I understood all of it. 

I was married at 21, but still took my transistor radio with me everywhere, like in the summer to the apartment's pool where I blasted it to the Mamas and Papas and Credence Clearwater Revival and Hall and Oates. My husband was not a music fan and called the singers maniacs, too. The next year, the transistor radio went in the crawl space along with my beloved dolls because I was all grown up. And I upgraded to the boom box.

I always loved music and that's why I loved playing the piano, by ear where I could play anything that was written. Those days are gone now because of my stroke, and with it a paralyzed arm, but I still tap my foot to the music.  In therapy, for instance, when I’ll have have my eyes closed and the therapist always comes over to me in fear that something's wrong. I'll open my eyes for a brief moment and say, "I'm not having another stroke. I'm just in the zone." You'd think the therapist would get it by now. Then I close my eyes again and groove with the music. It doesn't matter what genre--soft rock, hard rock, country. I love the musicmakers. So I wasn't surprised that music therapy has evolved to accommodate conditions like stroke, schizophrenia, heart conditions, and many more.

Medical News, an online mag, reported that music, in a positive way, affects the brain in social interactions and emotions, like less anxiety and reduced depression, giving people "quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization." Medical News also reported current research that suggests when traditional therapy is used with music therapy, it boosts the chances of success significantly in allowing the patient--inpatient or outpatient--positive emotions and motivation. One study concluded that there was "a decrease in blood pressure, heart rate, and levels of anxiety in heart patients." Source: http://www.news-medical.net/health/Music-Therapy-for-Stroke.aspx

Here's why: music has been shown to affect portions of the brain pertaining to control of muscles, mood, speech, cognition, and motivation. Research by Atasu Nayak, MD, has shown that music therapy is linked to a decrease in depression. Nayak and his group also found the more dysfunctional an individual's social behavior was at the beginning of treatment, the more likely the outcome that music therapy would be beneficial. Barbara L. Wheeler, PhD, et al found that group music therapy sessions boosted the ability of  stroke patients responded to social interaction, and individual sessions assisted with motivation for treatment. (Aretha Franklin's, toe-tappin' "Respect," please).

Rita Safranek, a writer in 2011 for Discovery Guides, said that stroke victims who participated in music therapy recovered functionally better than those who had not. She goes on to say that notions of music therapy exist in written texts dating back to ancient Greek civilization. In the last century, after World Wars I and II, musicians routinely visited veterans VA hospitals in the US to make music for those suffering emotional and physical hardships. In the late 1940s, Safranek said, the patients’ responses to music led the medical staff to ask that facilities hire musicmakers. As a result, the request grew into a college curriculum for music therapists.

Thus, the inevitable American Music Therapy Association (AMTA) came to be. The association’s membership is around 4,000 AMTA-certified professionals in the US. The first music therapy degree program was begun at Michigan State University in 1944. Around 70 colleges and universities in the United States now offer a bachelor’s degree programs in music therapy. Persons who complete an undergraduate degree in music therapy and subsequent clinical internships
are then eligible to take the Certification Board for Music Therapists’ national examination. Several colleges and universities offer advanced degrees as well.

Like all therapists, music therapists have to have goals like the patient writing music, playing a drum, and exercising to upbeat music. Since 1944, Medicare has been examining those goals and has identified music therapy as a reimbursable expense under benefits for hospitalization programs. The ever-growing requests for music therapy, and the ever-increasing research that supports music therapy, have created helpful third-party reimbursement for music therapy services.

"There is a pretty strong research foundation for music therapy," says Al Bumanis, Director of Communications for the AMTA. He says that music therapy can assist stroke patients to get their functioning back by rhythmic exercises, like walking in time with the music and singing to restore speech.

In the same vein, Oliver Sacks, a neurologist and author, wrote Musicophilia, a book music's ability to migrate us out of depression and about dancing to its beat. A review offers the following: Musicophilia offers mind-blowing stories of people of the powers of music "from a man who is struck by lightning and suddenly inspired to become a pianist at the age of forty-two, to an entire group of children with Williams syndrome, who are hypermusical from birth; from people with amusia, to whom a symphony sounds like the clattering of pots and pans, to a man whose memory spans only seven seconds — for everything but music."

For 7 weeks after my stroke in 2009, I stayed at the state-of-the-art Bacharach Institute for Rehabilitation, a world renowned New Jersey rehab facility (alluded to negatively as 'Rehab X' in my book, "The Tales of a Stroke Patient"). I asked the doctor all the time whether I'd play piano again. She knew I had the music gene, but even so, I was never afforded music therapy at Bacharach. There wasn't even background music playing. I couldn't tap my feet.

No music therapy? It's not an option. It's a necessity.

Jan 7, 2014

Chiropractors and Strokes: A Sometimes Twosome, aka It All Started with a Grocer

I once went to a chiropractor. I thought he was nuts, and I thought I was nuts to let him manipulate my neck. So it didn't happen. He charged me 95 bucks for an evaluation because only in certain limited circumstances is chiropractic covered by insurance. Before I reveal the relationship between chiropractors and strokes, it's background time, to put chiropractors, bless their crazy, little hearts, in proper perspective.

D.D. Palmer, a teacher, grocery man, and magnetic healer who once said that manipulation is the cure for all diseases for the human race, founded chiropractic medicine in 1895, attempting to merge science and metaphysics, i.e., an offshoot of philosophy that studies the bottom-line structure of reality, or from Merriam Webster's dictionary, "of that which is real, insofar as it is real," and based on its tenets of naturalism, magnetism, spiritualism, voo-doo (just kidding about the voo-doo), and other things that couldn't be proved by scientific methodology. Palmer's chiropractic treatise on spinal manipulation likened the body to a machine whose disguishable parts could be aligned and ultimately fixed, using no drugs.

Calling himself a self-proclaimed doctor, "Dr." D.D. Palmer built a magnetic healing facility in Davenport, Iowa, upsetting a writer at a local paper who said, "His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…. His increase in business shows what can be done in Davenport, even by a quack."

The contention didn't stop Palmer. After a long battle that started in the early 1900s, the philosophy of chiropractic medicine has given society a mixed bag of chiropractors which, said Joseph Keating, Jr., a disciple of Palmer's, in Keating's book, Philosophy in Chiropractic, "Despite their emphasis of manual therapy, [chiropractors] may vary on their perceived scope of practice, interventions and their role in the health care system." And there it is. That's another way of saying that chiropractic medicine has few protocols regarding how the chiropractic industry operates.

As far back as the 1960s, the American Medical Assiciation (AMA) announced that chiropractic medicine was an "unscientific cult." That decade also brought the AMA Board of Regents' "Committee on Quackery" with the principles of eradicating chiropractic medicine to ensure that Medicare should not cover chiropractic services. (They still don't cover much today). Every decade after brought refinement and more allowed services to chiropractors and those that seek chiropractic care. Still, many medical professionals, orthopedists in particular, do not recognize the chiropractic profession at all. And most doctors don't validate, if they validate it at all, chiropractic medicine for children.

In every state in the US, there's been suits against chiropractors for one

thing or another. Let's go through a sample in the recent past:
In West Virginia, a chiropractic firm was found guilty of insurance fraud, in convincing new patients that they had serious spinal conditions, even if they did not;
In Kentucky, "Dr." Paul Hollern taught his student chiropractors to sell patients needless services.
In Texas, an accident clinic was found guilty of overtreatment and unnecessary referrals.
In New Jersey, insurance fraud busted people, including chiropractors, for involvement in "staged" accidents.
In Illinois, ten Chicago area chiropractic clinics and five chiropractors, among others, were charged with the unlicensed practice of medicine, illegal self-referrals, fee splitting, and inflated and false medical claims.
In California, a bunch of chiropractors got indicted on charges that they were involved with massage-producing prostitutes.
In Florida, charges were brought against a chiropractor and others who allegedly committed social security fraud and insurance fraud where the insurance companies were billed for massages.

Sharon Hill, an Australian writer for Doubtful.com, who mission is to expose "quacks," zeroed in on many, uh, let's say, questionable techniques that chiropractors have used, some as recently as late as least year. She has written about actions taken against chiropractors who have no business, according to Hill, doing what they do. Hill covers the gamut, like a "cure" for diabetes in her August 26, 2013, edition. "Diabetic Solutions MD promises it can help cure diabetes through a step-by-step process and nutritional supplements that could cost you thousands. Don’t be misled by the MD in the title. The doctors pitching the supplements are licensed chiropractors whose practices revolve around marketing supplements and diet plans, Hill says. 

And in September 2007, Hill writes, Sandra Nette went in for a neck adjustment and wound up with a stroke. She said the chiropractor forged consent forms after the stroke. She remained in a "locked-in" position, meaning that she unable of walking and barely able to speak or swallow. She was offered an out-of-court settlement for an undisclosed amount. Or these titles: Animal chiropractic: Not all it’s cracked up to be (snakes, too. Snakes?); Chiropractic care for kids called into question; Chiropractors jumping on chance to capitalize on meningitis scare, and more.

All of those cases have some relationship to greed. I agree that I have

cast a shadow over chiropractic medicine and it's not because the chiropractic industry was founded by a grocery man. Hell, some of my best friends are in the grocery business. But there's even a darker side than greed: needless injury leading to strokes.

Science Based Medicine (SBM seen at sciencebasedmedicine.com) says one of the ways chiropractors make big money is spinal manipulation. On June 22, 2013, an article was written called Chiropractic Danger: Neck Manipulation and Strokes. The neck, the article explains, is twisted and turned in certain ways that are meant to reduce or completely eradicate pain. Many patients go back, year after year, seeking shortcuts to the chiropractors assumed with magical hands for some relief.

One report by SBM revealed that a 37-year-old woman had neck adjustment and a stroke ensued. The chiropractor didn't notice the symptoms--primarily weaknesses on one side of the body--after working on her neck. And the Internet is filled with stories like this one. Just Google "neck adjustment stroke" for the hell of it.

From Quackwatch, for example: "Some chiropractors advocate screening tests with the hope of detecting individuals prone to stroke due to neck manipulation. These tests, which include holding the head and neck in positions of rotation to see whether the patient gets dizzy, are not reliable, partly because manipulation can rotate the neck further than can be done with the tests. Listening over the neck arteries with a stethoscope to detect a murmur, for example, has not been proven reliable, though patients that have one should be referred to a physician. Vascular function tests in which the patient's head is briefly held in the positions used during cervical manipulation are also not reliable as a screen for high-risk patients because a thrust that further stretches the vertebral artery could still damage the vessel wall ([aka a stroke])."

And this, from a former chiropractor, Rob Alexander, M.D.: "I have been

doing a vascular surgery rotation for the past month, which is part of my postgraduate medical education. During my chiropractic training, when the subject of manipulation-induced stroke was brought up, we were reassured that "millions of chiropractic adjustments are made each year and only a few incidents of stroke have been reported following neck manipulation." I recently found that two of the patients on my vascular service that suffered a cerebrovascular accident (stroke) had undergone neck manipulation by a chiropractor, one the day that symptoms had begun and the other four days afterward."

Dr. Alexander continued, "If indeed the incidence of stroke is rare, one M.D. would see a case of manipulation-induced CVA about every 10 years. But I believe I have seen two in the past month! I therefore urge my medical colleagues to question their patients regarding recent visits to a chiropractor [who did] neck manipulation when confronted with patients that present with the neurologic symptoms of stroke. I also urge potential chiropractic patients to not allow their necks to be manipulated in any way. The risk-to-benefit ratio is much too high to warrant such a procedure."

And this from SBM's Harriet Hall on April 29, 2008: "I wonder how many people have heard that chiropractic neck adjustments can cause strokes. It isn’t exactly common knowledge. One organization is trying to raise public awareness through signs on the side of city buses (Injured by a Chiropractor? Call this number) and through TV commercials. I had never heard about this phenomenon myself until a few years ago, when I heard it mentioned on an episode of Alan Alda’s Scientific American Frontiers. I questioned accuracy, but I quickly found confirmation in the medical literature."

Hall goes on. "A typical case was that of 24 year old Kristi Bedenbaugh who saw her chiropractor for sinus headaches. During a neck manipulation, she suffered a brain stem stroke and she died three days later. Autopsy revealed that the manipulation had split the inside walls of both of her vertebral arteries, causing the walls to balloon and block the blood supply to the lower part of her brain. Additional studies concluded that blood clots had formed on the days the manipulation took place. The chiropractor later paid a $1000 fine."

Hall proceeds to say that chiropractors are well aware of the risk. "They have attempted to find ways to screen patients for high risk, but there is no reliable way to do so. Strokes are a major reason for chiropractic malpractice insurance payouts – 9% of claims paid by the major chiropractic insurer in 2002, the only year for which I was able to find statistics. Some chiropractors are now asking patients to sign an informed consent form before manipulations. If asked, most chiropractors downplay the risk, saying it occurs in less than one in a million manipulations. Many (perhaps most) chiropractors do not mention the risk at all.... Heat, massage, tincture of time, exercises, and other measures may offer symptomatic relief with no associated risks."

About 4 percent of all ischemic strokes are caused by blockages in the basilar artery system. The basilar artery supplies oxygen-rich blood to some of the most critical parts of the brain. Basilar strokes have been linked to chiropractic medicine. About 20% of all basilar strokes come from spinal manipulations, or about 1300 a year in the U.S. Chiropractic treatments have been proven for carotid artery strokes. If someone dies from stroke, vertebral arteries are not usually examined at the autopsy. In 2002, a study of patients up to the age of 45 who had a stroke revealed that they were 5 times more likely to have seen a chiropractor in the week before the stroke than in the control group. A group of Canadian neurologists issued a statement in the same year urging caution, education, informed consent, and other caveats to protect the public.

And this, from Dr. Stephen Barrett in his article, "Neck Manipulation and Strokes," a piece revised on September 29, 2013: "In 1992, researchers

at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo. The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tares of the carotid arteries."

Dr Barrett added that in 2001, "Canadian researchers published a report about the relationships between chiropractic care and the incidence of vertebrovascular accidents (VBAs) due to vertebral artery dissection or blockage in Ontario, Canada, between 1993 and 1998. Using hospital records, each of 582 VBA cases was age- and sex-matched to four controls with no history of stroke. Health insurance billing records were used to document use of chiropractic services. The study found that VBA patients under age 45 were five times more likely than controls to (a) have visited a chiropractor within a week of the VBA and (b) to have had three or more visits with neck manipulations. No relationship was found after age 45. An accompanying editorial states that the data correspond to an incidence of 1.3 cases of vertebral artery dissection or blockage per 100,000 individuals receiving chiropractic neck manipulation, a number higher than most chiropractic estimates.

Let me say, in defense of chiropractors, they all believe in what they say. And there are bad apples in every profession. But a neck adjustment? From a chiropractic philosophy that was started by a grocer who called himself "Dr"? Heh, heh. That's crazy.