Jul 21, 2018

Quirky Personality of the Stroke Survivor: Caregivers Are the Most Important Part

C’mon. You must know a stroke survivor, with 800,000 getting strokes annually, and that number is just for the United States alone! At the very simplest common denominator, this post is for:
* Stroke survivors trying to figure out why they're different from before
* Families/friends trying to understand the stroke survivors' change
* Caregivers who act as a bridge, aka lynchpin, between survivors and families/friends

First, some background. Scientific American's Jon Stone, a consultant neurologist, writes, "Friends and relatives may report a personality change that is hard to pin down. Some of these changes, such as low mood and anxiety, are more likely to be related to a person's feelings about having a stroke than to any harm to the brain." 

But he contradicts by saying (I am the critic, too), "A genuine shift may occur, however, when the frontal lobes sustain damage. The frontal lobes play an essential role in regulating emotion, decision making, and judgment." 

"A stroke that hits the cerebellum," he continues, "can also trigger a personality shift. This brain region is vital to many aspects of executive function. Damage here can bring about disinhibition, which often manifests as inappropriate behavior. Other “negative” personality changes include poor decision making, aggression, and irritability."

He also says less common are cases of “positive” personality changes, in which people reportedly become happier and even nicer. (I became more compassionate and less judgmental).

The Stroke Foundation of Australia lists changes in personality including inability to do anything, being irritable or aggressive, saying or doing things that seem inappropriate to others, and acting without thinking, and doing things that are not safe or are not appropriate. 

(In my book, The Tales of a Stroke Patient, I escaped from the sub-acute facility, and lived to tell about it, in search of soft-serve ice cream, ignoring safety concerns like traffic and mixed-up directions. Poor decision, right?)

In an article "The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work," written by Reg Morris and published by the venerable National Institutes of Health, the study is recounted that young stroke survivors have more practical and physical needs than old survivors. 

Stroke survivors under 50 years of age were studied, and found that family conflict and loss of home, employment, and spousal dissension were common practical problems. 

In summary: 
Employment loss was rated 80%–90%.
About half of survivors had psychological disorders, mostly depression or anxiety about work, recovery, and childcare.
A quarter to a third exhibited denial, anger, frustration, or hostility.
A majority expressed problems with employment, finances, social participation, and/or sexual problems.
Frustration was a main theme found in survivors under 55 years old, for up to two years after a first stroke. 
The frustration was related to fatigue that affected everyday activities and gender roles. 
Invisibility and "outside the loop" centered around lack of information and consideration of young survivors, a shortage of activities for the younger survivors, and the awareness of their apparent cognitive and yet "invisible" impairments. 

The austere Cleveland Clinic says the loss of a person’s former identity can result in depression, anger, and frustration which calls the grieving process, denial, anger, bargaining, depression, and acceptance, into play.

Some stroke survivors have difficulty with their communication skills following a stroke. They can be categorized in two general areas.

The first is speech disorders, says the Cleveland Clinic, and the second is aphasia, "the loss of ability to communicate normally resulting from damage typically to the left side of the brain, which houses the communication center." It may affect a person’s verbal expression, auditory comprehension, and the person's ability to read, write, and manage numbers.

"Some stroke survivors may have slurred or garbled speech as a result of muscle weakness or incoordination (called dysarthria) or motor programming of speech muscles (called apraxia)."

A Speech-Language Pathologist (SLP) will be on the scene to evaluate the patient’s communication skills and show ways in which the family can help. The SLP will also recommend any follow-up after the survivor is released from the hospital. 

And finally, the most important part in this post. The American Heart Association journal, a study was published and it was named "A Quantitative Study of the Emotional Outcome of People Caring for Stroke Survivors," i.e. caregivers.

In a randomized trial, the patients and caregivers were asked to complete 2 measures of emotional distress. A "regression analysis" was used to name the factors that were associated with poor caregiver outcomes.

Fifty-five percent of responding caregivers indicated that emotional distress is common. Caregivers were more likely to be depressed if the patients were severely dependent.

The study's main goal was to help to identify those caregivers at greatest risk of poor outcomes. 

I could have told you that. Hands down, every profession from street cleaners to neurosurgeons have people in those occupations that shouldn't be there. Yes, caregivers, too. You know someone who shouldn't be what they are if you really think about it. 

When it comes to caregivers, they are the most important of all. They are the lynchpin to find the common ground on which the survivors' antics, if you will, are understood by family and friends. 

It's all up to you, caregivers, because things happen fast in the world of stroke and other brain injuries, leaving the family and friends who come to see them, too soon in most cases,  bewildered and angry, and often times there is no source for that confusion and disarray.  It just happens. You can't blame the stroke survivor, yet many of them do.

So if you're a caregiver, DO YOUR JOB, and that means going the extra mile beyond bathing the poor soul and cooking the meals that aren't high on the priority list. Try to make sense, to the families and friends, of the stroke survivor's behavior. Or any brain-injured person, for that matter.

Otherwise, as I've said to the caregiver, more times than I'd like to count, "Get the hell out!"

Jun 21, 2018

PRP: Give a Little Blood, Get Some Amazing Results, Even With Hair Loss

Here's a question for you. What do Lakers Lonzo Ball (knee injury), golf's gift to women (only kidding) Tiger Woods (torn Achilles' tendon), and Brewers pitcher Chris Capuano (strained quadriceps) have in common? The answer is, they are professional athletes who all had PRP. In our over "acronym-ed" world, the term stands for Platelet-Rich Plasma. 

Sometimes it works, sometimes it doesn't. However, when it comes down to a possible career-ending choice, it's sometimes the right choice, born of desperation and hope. 

PRP, for ordinary folks like you or me, comes down to QOL (quality of life) issues, and that's just as important. 

PRP therapy is a nonsurgical treatment for individuals suffering from chronic tendon injury or osteoarthritis, for example. PRP treatment utilizes the patient's own blood to source platelets, which are then injected into the bothersome  area. In addition to pain relief with no surgery, PRP speeds up the healing process. The procedure takes less than an hour, and most patients return to pre-injury status within three months.

A single PRP injection costs $800, while additional injections in the same area cost $600 each, as of 2015. The cost of platelet-rich plasma treatment varies based on the amount of treatment administered, states Emory Healthcare.

OrthoInfo, a website published by the American Academy of Orthopaedic Surgeons (AAOS), says it may be beneficial for chronic tendon injuries, acute ligament and muscle injuries, surgery and fractures to make recovery faster, and knee arthritis. The AAOS also says the following: "There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections."
What you probably haven't heard of is that there's a similar treatment for hair loss, and yes, it requires your blood.
It's called platelet-rich plasma, too, says Joshua Zeichner  the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. 

"Our blood is made of two main components, red blood cells, and plasma," he says. "The plasma contains white blood cells and platelets, which are rich in growth factors."

Beginning with a standard blood draw from the patient's arm, there is a careful process involved in using PRP for hair regrowth. 

Zeichner says, "The tube of blood is put into a machine called a centrifuge, which spins the blood tube to separate out the red blood cells from the plasma. The plasma, rich in platelets, is then injected directly into the scalp at the level of the hair follicles." [Ouch!]

The process is precise with injections beginning across the scalp, approximately at every half inch over the area of thinning hair. The procedure takes less than a half hour. There's no documented risk associated with PRP. 

"Most patients get injections without any numbing, as there is minimal discomfort," says Zeichner. "However, cool air or ice packs may be used to minimize pain." In the event there is any after-procedure pain, Zeichner recommends Tylenol. Bruising can occur but usually is resolved within a week or two.
Zeichner adds, "I personally recommend a warm shower, as the hot temperature will enhance blood flow and circulation throughout the scalp. PRP is best used for patients with androgenic alopecia, which is a genetically determined type of hair thinning that typically occurs along the top of the head." 
Treatments are typically performed once a month for the first three to four months, and then every three to six months, depending on the patient's response and results. 
"The first result that patients usually note is decreased hair shedding, followed by early regrowth and increased length of hair," says Dr. Neil Sadick, a dermatologist in New York City. He illustrates:

"The general consensus is that receiving treatments every three to six months on a long-term basis are optimal for continuing to stimulate the growth factors and stem cells that are associated with regrowth and stopping hair fallout," says Sadick.

Maybe I'll look into PRP for my re-fractured rib and my poor posture affecting my spine from my stroke. Desperation, hope, and quality of life. There they are! Just like I said!

Jun 2, 2018

When Is Enough Exercise Enough?

[This post is to all chronically-ill people, their caregivers (or personal assistants as I call them), their family, people who suspect a chronically disease eventually because it runs in the family, and that equals a lot of folks.]

I came across this statistic: By 2030, as many as 11 million people could be living with stroke as more people live longer. Yikes. Research time.  

The title from Flint RehabMore Is Better… Except When It’s Not, caught my eye. 
Flint Rehab says, "While repetition [of exercise] is important, too much exercise can start to hinder your progress. [Uh huh.] You need a good amount of rest and sleep in order to successfully recover."  

Something, but still nothing that answers my question specifically.  

And it got me thinking, because most times for me, it's never enough. Then when I hurt badly, aka when enough is more than enough, I turned to guilt because for several days, I rested my weary bones. One step forward, one step back, kind of thing. No progress at times. None at all.

When I achieved rest, and dreaded naps, it messed up my sleep, aka circadian rythyms. Then I couldn't go to bed before 3am. That's 3am on a good night. Now, I don't take any naps. And yes, I am tired, but it's a trade-off. I want to have good results with my exercise instead of giving in to my fatigue.

Now, I set the alarm on my cell for 15 minutes no later that 1pm. The power nap routine! That's just enough rest to re-fire my engine and sleep, aka nap, or not fall asleep. With my  eyes closed, it's still rest.

But I digress. This post is not about circadian rhythms, let alone mine. It's about exercise, specifically, "Am I doing enough exercise and how do I know when I reach that point of, it's enough?"

The Stroke Foundation across the other pond, aka Australia, says the repetition is the main focus on improvement. 

"Regular activity will help you to continue your recovery. Exercise improves your fitness, your general health, and reduces your risk of having another stroke." 

That means not when you feel like doing it but doing it every day. But nothing in that article addresses "when is enough exercise enough." I plowed on.

Then I came across this: Exercise is a valuable yet underused component for post-stroke care, according to an American Heart Association/American Stroke Association scientific statement. [Hmm. Now we're getting somewhere.]
"There is strong evidence that physical activity and exercise after stroke can improve cardiovascular fitness, walking ability, and upper arm strength," said Sandra A. Billinger, P.T., Ph.D., lead author and a physical therapist at the University of Kansas Medical Center in Kansas City, KS.
[Read more, I said.] 
"Yet, too few healthcare professionals prescribe exercise as a form of therapy for stroke. There is a big gap in America once stroke patients are discharged from rehabilitation and the transition to community exercise programs when they go home. Many are left on their own. [I was.] We don't have a system in place to help stroke patients feel comfortable with exercise.

And here it was:

"The general recommendation," says Billinger, "is that survivors exercise at least three days a week for 20 to 60 minutes, but that depends on their individual functional capacity. For many stroke survivors, multiple 10- to 15- minute bouts of moderate-intensity exercise may be better tolerated.

Aah. Hard data. At last. I was striving to do the exercise every day. It was too much, the good doctor implied. Every day. Core strengthening, 15 reps, 3 sets, the same with marching and leg stretches and Thera-band leg pulls and lifting my legs outward and behind me while holding on to the countertop, one leg at a time, and walking the halls for 500 feet, and weights, left hand only. 

Now I alternate with walking the halls and weights, and the other stuff aforementioned. I just started last week but no pain. I feel the good hurt. Life is good at the moment. I have the feeling that I found the key.

But Stroke is an ongoing mystery to find the other keys. Always a key. 

May 13, 2018

10 Things You Probably Didn't Know About Brain Bleeds

It's quiz time! 

If a hemorrhagic stroke could happen to me, with both low cholesterol and blood pressure, no diabetes, and a non-smoker, it could happen to anyone. Or is it an aneurysm? Now I know! And even more.

Here's 10 questions about brain bleeds. Write down your answers and compare them with the real answers below. Let me know how you did. 100%? In your dreams! (But maybe). Good luck.

1. Is a hemorrhagic stroke the same thing as an aneurysm?

a. Yes, they're the same

b. No, but a hemorrhagic stroke is one of the most usual kinds of a ruptured aneurysm

c. No, but a ruptured aneurysm is one of the most usual  kinds of a hemorrhagic stroke

2. A cerebral aneurysm is

a. a thin or weak spot that can occur on a blood vessel of the brain

b. random with no known cause

c. a thick spot that can occur on a vein in the brain

3. A hemorrhage stroke

a. is not emergent and which requires immediate bed rest at home

b. is a medical emergency that requires immediate treatment

c. is a medical emergency that always requires an operation

4. A hemorrhagic stroke

a. is more common in women than men

b. is more common in men than women

c. splits 50-50 among genders

5. Symptoms of a hemorrhagic stroke usually occur 

a. when the person is awake

b. when the person is asleep

c. both a and b

Most brain aneurysms

a. don't rupture

b. don't create health problems or cause symptoms

c. both a and b

7. Although aneurysms can appear anywhere in the brain, they are most common in arteries

a. at the top of the brain

b. at the base of the brain

c. anywhere in the brain

8. Go to the hospital immediately if

a. you have a mild headache

b. you have the worst headache ever

c. if you have insurance

9. Among the first blood tests in the event of an ruptured aneurysm is to determine

a. your ability to clot

b. your stress level

c. your cholesterol 

10. Usually, hospitalization is followed by a period of living in a rehabilitation center, where additional intensive stroke therapy may be provided

a. to assist the patient with financial responsibilities

b. to help the patient recover as much physical and speaking function as possible

c. to make the patient aware of all the negatives

Answers: 1. c , 2. a, 3. b, 4. a, 5. a, 6. c (a brain aneurysm that doesn't rupture is often detected during tests for other conditions), 7. b, 8, b (whether you have health insurance or not, the hospital has to treat you, but you may wind up with a huge bill if you don't have health insurance), 9. a, 10. b

Apr 8, 2018

Acupuncture--It Isn't For The Faint Of Heart, aka Needles In My Body? You've Got To Be Kidding!

I have, at times, a painful lower back and, since we're enumerating, a restless leg and arthritis in the hip, as a result of the stroke, the latter from bad posture I constantly (except when I'm not) try to correct. I tried everything around the house--heat packs, cold packs--and wasted a lot of money on Lidocaine-based, over-the-counter products from the pharmacy. But three weeks ago, I had an epiphany, truth be told, from desperation. Acupuncture! There are many places in Portland that offer it. But first, a little background.

Acupuncture, in a broad context, is a process in which skilled practitioners insert fine, thin needles through the skin in an effort to eliminate or lessen pain in the lower back, neck, and osteoarthritic knee, headache, migraine, dental pain, and nausea, for example.  The downside is substantial if a practitioner uses non-sterile needles which can cause infections, punctured and collapsed organs, and injury to the central nervous system, but in the hands of an experienced practitioner, (and if you're desperate enough), in my opinion, it's worth a try.

With the help of herbs, diet, and massage, acupuncture flourished in China and slowly spread around the world but was disdained by Western medicine. Yet today, even in China, there is confusion and mystery over just how acupuncture works.

From the NIH (National Institutes of Health), comes the bottom line: "Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

"The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain."
This from one site: Check acupuncturist's credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. 

 I did and found this:

Although a license does not guarantee quality of care, it does indicate, Dr. Lu in my case, that the clinician is up to standard in the use of acupuncture. Some conventional medical practitioners—including physicians and dentists—practice acupuncture. But I couldn't find one. Ergo, Mercy and Wisdom Clinic. 

Mercy and Wisdom is weird both in the waiting room and the acupuncture rooms, the former having very low seats that I struggled to get out of and the latter, simply put, old fashioned with its high examining bed and it archaic case for supplies. But other than that, Dr. Lu knows her stuff. 

When I first met her, she explained how Chinese medicine was different than the Western kind, in engaging detail. It was all about having blockage where you shouldn't. And then the needles came out. It hurt at first, but Dr. Lu reassured me that the needles were placed where they were needed because if they went in to easily, that means they weren't addressing the blockage. The hurt went away in less than 5 minutes.

The needles, and 20 more, stayed in for an hour, and they were placed in something she called channels. She said my arm which has been dead for nine years could move, too. Dr. Lu suggested I'd walk for exercise. So I did, up and down the hall. My assistant, Joyce (I call her Joyce 2), came with me each time, and she was a key factor in my relaxation. Dr. Lu said I have to go a month to notice results with my sore lower back, my restless foot, and arthritis in the hip. She told me to avoid the night shade vegetables and fruits for arthritis: eggplant, tomatoes, peppers, and potatoes.

I stopped taking the Oxycodone after the 2nd visit. Maybe there is something about pain and acupuncture after all. I'll write and let you know when I take a significant step. 

Mar 15, 2018

My Sons, My Sons and the Makeshift Playroom

I have two sons. 

It was in the late 90s when a childless friend asked me during a hectic, weekday lunch, out of the blueish of blue, "Do you think I missed anything by not having kids?"

I answered him directly, "You love to travel. You went to places I didn't know exist. Travel with kids isn't always a possibility." 

But to myself, I silently shouted, "Hell, yes!" 

When my boys were young--one 7 and the other 2--I built them a playroom in our dingy basement with exposed pipes and a low ceiling, albeit high enough for them. Earl, my handyman, bought fluorescent lights and hangers that suspended them (that made the ceiling a teensy-bit lower). 

He bought a used television (he knew a guy) from which they would play video games. He installed a solid shelf for the television because boys will be boys. (If you don't know what that means, ask someone with two or more sons). 

He installed a heater/air conditioner unit because my thought process was it will be a 12-month to do. (And it was). He paneled part of it (my idea) and painted the rest (his idea) a soft yellow. And last, he installed a rug bought as a remnant but covered the whole floor because he made it fit. (The rug had 5 seams and Earl was good at math).

When it was finished, I brought the kids downstairs to see the outcome. It might have been put together cheaply, but it was the "playroom" and they loved it. 

Soon after, I built a 4x6 train set with fast-moving trains and railroad crossings and tiny people waiting on the platform in the playroom. Even though the planks of wood were wobbly (upper arm strength isn't my forte), it satisfied my sons.

I catered parties down in the playroom. Birthday parties, half-birthday parties, graduation parties starting with preschool. And more parties just for the sake of parties, many of them sleepovers. 

And then one by one, they left for college and stayed there after graduation in two respective different cities, both 6 hours from the house. That playroom existed as a monument to great, great times. 

It was followed by my bouts of depression and I asked the biggest question over and over again: Is that all there is? Sullen moods went on for a bunch of years until the youngest one graduated from college. And then a miracle happened a few years later. 

Both boys invited me, in the same year, as a guest visitor to see what they did for work. The older son, a Senior Programmer, showed me his workspace and explained in detail what he did to make things work and do what they did. My younger son, a Systems Administrator, showed me his workspace and what he did for networks, the lines of communication, to exist.

It was then I stopped thinking of them as children and moved on. 

My two sons were making a contribution and were self-sufficient. Isn't that what every parent wants? 

My stroke happened shortly after, and I knew, in all that despair, that my sons were going to be fine. Every time I thought that way, it led me to smile. 

Feb 11, 2018

Oxycodone and Me, a Failing (and Falling) Relationship

I last wrote the blog around Thanksgiving. And then I stopped altogether. Not because my ideas ran out. This post is now written and published, taking me 5 days in the process because of the pain when I sit too long. 

Let me give you the timeline and you'll see the consequences rather quickly, I imagine.

November 28: I had ear surgery because my eardrum had a hole in it caused by increasingly larger tubes to hear. The surgery was successful and the Oxycodone was effective to avoid the ear pain. 

November 28-December 5: I have a low tolerance for pain and took 7 to 9 Oxy tablets the first week to maintain my level of comfort. 

December 6-13: Then the second week 6 to 8. I wasn't a drug addict yet but on my way because, truth be told, because Oxycodone is a narcotic, and the rate of people taking taking too much narcotic(s) and dying is at epidemic proportions across all populations--the rich and poor, the professionals and the unemployed, the brain trusts and the brainless. Thus, I always asked myself, Am I in pain pain or is the pain tolerable? But I always opted for the Oxy because I had become chemically addicted. 

December 18: I was in the beginning of my third week taking Oxy as much as the second week when I fell to the floor around 1am and hit the end table next to my bed. I called my son to bring the key over to let the paramedics in on my iPhone, or what I call my lifeline. Then I called the paramedics and soon realized, in the post-surgery, perpetual state of Oxy-controlled haze, that I should go the hospital because I hit my head from a standing position and my ribs ached.

The ambulance, with sirens flashing, brought me to the hospital and while there, the ER doc ordered a CT scan of my head and X-rays. He gave me Tramadol and then Dilaudid to ease the pain. Then he gave me Oxycodone, the drug I had been taking following the ear surgery. The results of the tests showed my head wasn't affected, but 2, maybe 3 of my ribs were broken. The ribs take roughly 8 weeks to heal in a young person. Mine will take longer.

December 18-January 23: I ended up in the rehab facility across from the hospital. By the time I left the facility, I was down to 2 Oxycodones daily. Now I avoid them sometime because the pain is less and it is tolerable. I was chemically addicted and now 2 or less a day. I consider myself lucky, addicted-to-narcotics wise. 

January 23 to present: I returned home. My doc ordered 60 more Oxy just in case I still had ongoing pain. They're still waiting at the pharmacy. 

Of course, it was the Oxy that made me lose my balance and fall. I should have taken my time instead of going at my normal pace. But the Oxy operates differently. It makes the brain think it's invulnerable. 

Bottom line: I didn't read the brochure from the pharmacy that came with Oxycodone explaining the side effects like dizziness and the falling risk, but I should have. Oh, yeah. Lesson learned too late.

Nov 18, 2017

Go to Hell, Black Friday! aka The Top Ten Things I Am Thankful For On Thanksgiving

Right around this time of year, I often write about the misadventures of Black Friday, but I've finally learned not to participate because as a stroke survivor, I have fears of getting trampled or shot or assaulted, though it's not without basis, and one of so many stories.

Here's an example that occurred in 2011 as reported by the Huffington Post that game me pause. "A Black Friday shopper who collapsed while shopping at a Target store in West Virginia went almost unnoticed as customers continued to hunt for bargain deals. Walter Vance, a 61-year-old pharmacist who reportedly suffered from a prior heart condition, later died in the hospital. Witnesses say some shoppers ignored and even walked over the man’s body as they continued to shop." (Want to see more? Go to http://blackfridaydeathcount.com. You might be Amazon shopping this time forever after!)

Anyway, this time I am posting about what I am thankful for on Thanksgiving (in that partially made-up story about the Pilgrims and the Indians whose land we stole even though the Indians were here first. Just sayin'). Make no mistake. Those who know know me realize that my life had given me tough times, some necessary detours, to get around the shit tossed my way, and this is not a time, meaning never, to elaborate. So here are the top ten things for me to be thankful for.

1.  I am grateful that I am alive. I was close to death 8-1/2 years ago, with no thanks to my hemorrhagic stroke, but here I am, getting up and dusting myself off when another piece of crap goes flying my way. Why am I here still? As my son says, you're too annoying to die. Granted, I am pushy, and with that comes the will to live. And positivity is a part of that attitude. But the overwhelming positive side, truth be told, is, if I wasn't laughing, I would be crying, making my baggy eyes even baggier. So every day, I make a concerted effort to wake up happy, even if I'm not, because who wants to waste all that energy on being negative. (Sorry for that, but that's what's called an interior rant, aka stream of consciousness).

2.  I am grateful for my 2 sons (who shall remain nameless) who give me thoughtful insights at times when I most need it. I give them thoughtful insights, too, with the response always being, "Mom! Don't try to FIX things! You're meddlesome!" They say I am controlling, and maybe I am, less so as the years go forward. But I know they heard me and will think about my words, often later taking my suggestions. I don't say a word.

3.  I am grateful that I learned about a year ago how to successfully (the operative word) tie my shoes one-handed. This procedure, too, was borne of necessity. There just isn't somebody around at times. Video forthcoming in YouTube.

4.  I am grateful that I learned that the best Personal Assistants anticipate my needs without my saying, "Could you...." The only two that showed up for the interview in Speedboat Coffee in Portland (I was expecting eight) were Norma and Joyce #2. I couldn't ask for better. I often say, "Thank you! Thank you! Thank you!" And I mean it.

5.  I am grateful that I learned, through my weekly sessions in counseling, not to live in the past. The sessions went on for about three years. I'm a slow learner, meaning I'm bright yet stubborn, and it took a lot of time for my counselor to break through the barrier of obstinance. Great work, T.

6.  I am grateful that I learned that I shop online just to make me feel better. Amazon Queen, they call me (not to be confused with Queen of the Amazons, a 1947 flick where a woman's husband has disappeared on an expedition into the jungle and she discovers that he has been captured by a savage female tribe. Campy, right?) After many procedures and an operation, not counting the two upcoming this month, what's wrong with a little shopping therapy! It's cheaper than "talk" therapy and at least I enjoy the online trip with laughter and total glee without ordering needlessly.

7.  I am grateful that I learned that I like a lot of plants. I mean, OBSESSIVELY A LOT! Around twenty in front of an almost floor to ceiling, three-paned window. I'm allergic to cats and I can't walk a dog, plus birds are too much work, and fish don't do it for me. But my maternal instincts are still in play, so I take care of plants. Rather, my Personal Assistant waters them, feeds them, and gathers errant leaves that have somehow fallen off. I just watch them, keeping a loving eye on the plants that never move.

8.  I am grateful that I learned about the iPhone, more than just texting and clicking an app to activate it. Katie and Jody in Pittsburgh taught me so much and now Norma and Joyce #2 have taken over. But I'm grateful also that I can text with one hand. Life is good. I got the iPhone later than most people. Read about it in my post from 2015: https://stroketales.blogspot.com/2015/01/why-i-still-have-flip-phone-aka-i.html

9. I am grateful that I am never once bored in my apartment. Between writing, reading, and going to the refrigerator or kitchen cabinet to give me an excuse once an hour to stand and move, sometimes often without hunger, I keep busy. See my post about sitting too much: https://stroketales.blogspot.com/2013/07/the-5-ws-and-h-of-getting-up-and-moving.html

10. I am grateful that I am not associated in any way with Donald Trump, Louis CK, Kevin Spacey, Harvey Weinstein, Bill Cosby, and scores of others, some of them still yet unknown, who brought shame upon themselves and anger, tears, and painful memories to their victims.

Now that we ended on a bad note, let's get back to the point. So tell me, dear reader, what are YOU thankful for? Write in the Comments section below. And Happy Thanksgiving!

Nov 12, 2017

Stroke Survivors Alert: The Way to Nap, aka It's Siesta Time!

Cornell University social psychologist James Maas coined the phrase "power nap." Just 15 or 20 minutes each day, sometimes twice a day if your day is long enough, will give you new-found energy. The reason for just 15 or 20 minutes is, any longer and it will make you groggy because your body will ultimately fall into deep sleep, and waking up during a deep sleep stage makes no sense.

The CDC says (if it isn't sleep disturbances such as nightmares from the medication or leg spasms that go on and on and, yes, on), more than one third of us are sleeping less than the recommended 7 to 9 hours each night.

"The power nap is a godsend," Dr. Maas added, sleep expert and past chair of the Psychology Department at Cornell University. "If you want to nap longer, make sure you have a solid 90 minutes. That'll allow you to get through a full sleep cycle, so by the time you wake up, you'll be back in the lighter stages of sleep and able to get up and actually feel refreshed." 

Dr. Rachel Salas, associate professor of neurology at Johns Hopkins, says, "Humans have a normal, natural dip, in our circadian rhythm, in the afternoon. That’s actually prime time to take a nap." Especially that post-lunch energy crash, she adds. 


Many experts say make the surroundings as dark as possible and use earplugs or even download a white noise app from your phone. Salas recommends an eye mask, too, because light can pass through the eyelids and still be disturbing your ability to take a nap.

The "coffee nap" has been talked about, too. The thinking is  if you drink a cup of coffee, set your alarm for 15 or 20 minutes, and take a power nap, the coffee takes about 20 minutes for caffeine to absorb into the body and then you're prepared to awake.

But Maas says, "Anybody with insomnia should never power nap, because it's going to make it worse. If you're having trouble going to sleep at night or have disruptive sleep where you're waking up in the middle of the night, the first thing you have to look at is if you've been napping during day." 

That recommendation also applies to sleep apnea. "Even a short nap can be unrefreshing if the quality of the sleep is disrupted by apnea," says Maas, who suggests seeing your doctor or a sleep specialist to rule out any underlying sleep disorders.

My problem was, I'd gotten into a bad habit. Because my Personal Assistant liked to sleep in, I started awakening at 11am and nodding off at 4am . Now I know better. Even if it's a 2-power nap day, I go to sleep at 11pm and arise at 7am. It was a hard transition getting to be an early riser--it took me about 3 weeks, but it was worth it. Carpe diem!

Oct 29, 2017

In the Hapless Wheelchair: Talk To Me When You're Talking To Me!

It was a recent HBO limited series called The Newsroom. Starring Jeff Daniels as Will McAvoy, a cantankerous insomniac and often narcissistic news anchor, he became involved in a scuffle with the producer (Thomas Sadowski) who calls Will a scumbag (not exactly his words--worse even), but the producer addressed Charlie Skinner (Sam Waterston), the news director, instead of Will, and Charlie said, "Talk to him when you're talking to him."

You got all that? It's very important that you do because of the next part of my story. If not, re-read.

So this is what happened yesterday, but it's sort of the same story that happens every time since I had the stroke. Sitting in the wheelchair doesn't help, but for long trips like Walmart or the supermarket, it's a necessity. A man or woman addresses my Personal Assistant, who travels with me because I am disabled and cannot drive. But this crystal clear-thinking woman--me--is ignored. Somehow, I become invisible, a ghost, or I am addressed in the third party.

The woman in Kohl's says, "What is it she's looking for?"

The man in Dollar Tree says, "Does she want red or blue?"

The teenager at the check-out window in Dunkin' Donuts says, "Should I make her tea iced or hot?"

"Hello," I said to myself silently. "I'm right here."

Ultimately, I got tired of the ghost role and this is how I empowered myself to do something. Big time.

I was in the Department of Motor Vehicles to inquire about the status of my identification card, aka my non-driver driver's license, which never arrived in the mail. We went up to the window and, because I was sitting in the wheelchair, my PA, who was eye level with the representative, asked about its whereabouts. The line behind us was extensive.

"I don't know. Let me check. Do you know when she applied?" asked the man.

"Three weeks ago," my PA said.

"Oh. Here it is. There was some quirk in the system and it wasn't sent out. Let me try again. Here's an Oregon certificate of residency [which I didn't have anymore] that should help her out if she's needing it. But she shouldn't. You're her driver, aren't you? And she's not going out of the country," he chuckled.

That was it. The crushing chuckle, bordering on guffaw. With the seemingly endless line in back of us, and with the wheelchair locked, I stood up straight at my full 5', 5", tired of being a ghost any longer. I turned a bit to broadcast the message.

"As a matter of fact, I am going out of the country," I lied and shouted with unabashed glee. "I'm the Goodwill Ambassador for Russian Diplomatic Affairs, appointed by the president himself. I'm leaving Friday," I said, taking the first country that came in my mind a la Trump and the title I made up as I went along, leaving the first 10 people behind me looking with a newfound admiration.

I added, "And by the way, talk to me when you're talking to me."

I sat down in the still-locked wheelchair, looking serious as ever. She unlocked my brakes and we turned and left. I was proud of my exuberant bullshit, even prouder that I advocated for myself. I willing to say that man learned a lesson. But then again, maybe not. Either way, I was overjoyed at my newfound readiness for extemporaneous speech which I didn't have ever after my stroke.