Mar 23, 2017

Cigarettes, Second-hand Smoke, and Even E-cigarettes (aka Vaporing) Can Give You a Stroke, aka You're Playing With Fire

My mother who didn't work used to smoke a lot, notably in the bathroom where she said smoking would hide the smell of poop. (It didn't, in my opinion). She also smoked for hours on end when she was talking to "Aunt" Eleanor, her best friend. She smoked when she sat outside at night in the 1950s and 60s with the neighbors--the Craigs, the Scotts, the Lynches, the Groffs, the Baldinos--and she smoked when she was preparing every decorative, Betty Crocker-like meal, and a few cigarettes after, because she said cigarettes were relaxing. 

She most likely smoked more when we were at school. She probably smoked a pack or more of cigarettes daily for 45 years, and she didn't get cancer, or emphysema, or high blood pressure, or any--but one--of the things that smoking a pack or more of cigarettes daily for 45 years will give a person. She got a stroke.

Heart disease and stroke are often glopped together because they fall into the category of cardiovascular (heart and blood vessel) diseases (CVDs). 

In the United States, heart disease includes the most common type--coronary heart disease, which is narrowing of the blood vessels that carry blood to the heart. The narrowing can cause chest pain, arrhythmia (when the heart beats irregularly, too fast, or too slow), or heart attack (when blood flow to the heart becomes blocked and a section of the heart muscle is damaged or dies), or heart failure (failure to get the organs to survive because the heart cannot pump enough blood and oxygen).

Similarly, a stroke occurs when a blood vessel in the brain bursts (hemorrhagic stroke, which is the kind I had), causing brain tissue to die, or when the blood supply to the brain is blocked (ischemic stroke). Stroke is one of the leading causes of disability, or even death.

Smoking is one of the major causes of CVD and results in one of every 3 deaths. Smoking can: 
  1. Increase the buildup of plaque in blood vessels
  2. Cause thickening and narrowing of blood vessels
  3. Make blood thick and more likely to clot
  4. Raise triglycerides and lower good cholesterol (HDL)
Even if you don't smoke, second-hand smoke, the smoke from a smoker breathed out by burning tobacco products, harms your health, too. 

Breathing secondhand smoke can cause coronary heart disease, including heart attack and stroke. I've already told you about my mother. And my father smoked cigars. I was doomed. Here are the highlights:
  1. Each year, second-hand smoke exposure causes more than 8,000 deaths from stroke. 
  2. Nonsmokers who breathe second-hand smoke at home or at work increase their risk of developing heart disease by 25–30%. 
  3. Second-hand smoke increases the risk for stroke by 20−30%.
  4. Even briefly breathing secondhand smoke can damage the lining of blood vessels and cause your blood to dangerously thicken.
The most alarming news in a recent study has found that people using e-cigarettes may be at higher risk of a life-threatening stroke than ordinary cigarette smokers.

Why? Here's how E-cigarettes work. They work off of battery-power that when drawed on, aka inhaled, gets liquid nicotine into an inhalable vapor. The vapor doesn't have the chemicals and tars of addictive burning tobacco, and so e-cigarettes were initially considered safer than cigarettes.

But recent research at Johns Hopkins University used mice who were exposed to e-cigarette vapor for 2 weeks and were found to have greater nerve damage, and their lungs were less capable of fighting off viral and bacterial infections when compared to mice not exposed to the vapor.

One researcher said, “Vaping is not safer than tobacco smoking and may pose a similar, if not higher, risk for stroke severity. Stopping smoking is the single most important step you can take to improve your heart health."

The British Heart Foundation is funding research to find out "whether or not they are as safe as people think.” The devices are targeted at helping people quit smoking cigarettes, but they have been ironically called the “gateway to smoking.”

A study reported in February 2017 said that e-cigarettes may be just as detrimental for your heart as smoking ordinary cigarettes. The researchers observed that vapers were more likely to show signs of two key heart risk factors: increased levels of the hormone adrenaline in the heart and increased oxidative stress (an imbalance between the  oxygen and the body's willingness to detoxify or to repair the resulting damage).

E-cigarettes were introduced around 10 years ago and currently have about 9 million users.

The Centers for Disease Control and Prevention (CDC) reveals a shocking increase in nicotine poisoning incidents, which "can be toxic, even fatal, to children even in small doses." Additionally, inhaled nicotine increases heart rate and blood pressure, one of the major causes of stroke.

The Food and Drug Administration in a remarkable move in May 2016 administered legislation extending federal authority over e-cigarettes. "This action resulted in banning their sale to anyone under 18 and requiring adults under 26 to show photo identification," The New York Times reports.

People reading my post won't necessarily stop smoking just because I said to stop. And they won't necessarily stop smoking just because some health professional told them to stop. People are funny like that. They'd probably only stop smoking when something catastrophic happens to them. Like stroke, for instance.

Mar 11, 2017

NOT BREAKING NEWS: Somewhat Crazy Twice?

Years ago, I was with a friend whose son developed panic disorder from smoking weed. The 22-year-old son had the presence of mind to come to my friend's house. He was lying on the sofa, almost breathless, crying intermittently, begging for help. My friend, who was his father, talked patiently and helped calm him down in two hours. For some of you, maybe talking a mental disorder through will help also, and be enough.  But start at the hospital ER if talking doesn't fix the problem. Mental conditions can be rougher than a stroke! "Head stuff" almost always is. 

Years later, I wondered about mental disorders as related to stroke, and this article popped up. Under the title, Study Links Psychiatric Disorders to Stroke Risk, comes this disheartening news from National Institutes of Health (NIH), published on February 23 of this year:
"Getting care at a hospital for a psychiatric disorder may be linked to a higher risk of stroke in the following weeks and months," new NIH research suggests.

Oh, great, another reason to worry, especially for people who already have depression, anxiety, or post-traumatic stress. Now they might have both--a stroke and one of the aforementioned. Here's what the researchers  found out.

People with mental conditions, stroke or no, possessed a triple threat of stroke--or another stroke--following their stay in the in-and-out ER or for a prolonged stay in hospital bed.
The threat of stroke began to decrease after 30 days, but "remained twice as high for at least a year after the ER visit or hospital stay," the researchers discovered.

"We have known for some time that people who have a stroke seem to be at an increased risk for later on developing some sort of psychiatric illness, depression or post-stroke psychosis," said the lead study author, Jonah Zuflacht.
Zuflacht went on to say, "But what has been less studied is the inverse of that. Meaning, if you have some sort of psychiatric illness, does it increase the risk for stroke?"

The conclusion? The ER visit or hospitalization for a psychiatric disorder was associated with a higher risk of stroke. The research team said the body might go into overdrive with a "fight-or-flight" stress response, elevating  blood pressure, a leading cause of stroke.
"The other possibility,"  Zuflacht added, "is that there are behavioral reasons at work. For example, are these patients not taking the medications they should be taking to prevent a stroke--like their high blood pressure meds--because of their mental illness?"
The study from California's Healthcare Cost and Utilization Project analyzed more than 52,000 stroke events--equally divided between men and women--that had taken place between 2007 and 2009.
The team discoved that more than 3,300 patients (or 6%) had hospital care for a psychiatric illness at some point in the year leading up to their stroke and were more likely to be female. 

The risk of stroke tripled within the first 15 days after receiving mental health care and dropped slightly afterwards, but was still more than triple the normal rate of having a stroke one month out, with the risk more than double the norm through the 12-month period.

It's not surprising to me, though, and I think it's more than an increase in blood pressure. The psychiatric illnesses may result in other things, too, like increased eating of junk, aka fast, food (, going on alcoholic binges (, or elevating your cigarette smokes (post eventually coming), all causes of stroke. 

Feb 13, 2017

Caregivers Are Suffering; Stroke Survivors Are Suffering: Who Has It Worse?

The former editor-in-chief of the Philadelphia Daily News was Gil Spencer who said, when I was hired as a columnist, that the only reason people should write is to be read, whether it's positive or negative to their beliefs. Those words are indelibly inscribed in my brain forever. And I was reminded of them again in this post on Facebook.

On January 17, at 8:07pm, I wrote this in Facebook to the group called "Stroke Caregivers." My words set off a firestorm of anger, confusion, and profanity, all of which are ok. One person wrote, "GFYS," an acronym I didn't know. So I goggled it, and I found out. (Between you and me, I think GFYS is silly because our anatomies aren't built that way. How can you fuck yourself?) Anyway, read the comments. Some agreed with me. But I removed the names of those who didn't because I don't want bogus lawsuits, (bad spelling and grammar aside), and I deleted more because of repetition. But I left my name in when the response was needed. After you read them, I'll have thoughts of my own.

I wrote, "As a stroke survivor, and from all that I've read in your posts, we BOTH have it tough. But really, you can still dance. Get what I'm saying?"
Hmm... I usually don't respond to these kinds of posts; but this 'keeping track' of who has it harder has no benefit. I would never say my husband who had a massive stroke that left him paralyzed on his right side, without 40% of his sight, and plagued with severe cases of aphasia and apraxia that leaves him unable to use any expressive speech has it 'better' than me. No more than I would say my daughter with Down syndrome is luckier than me; however, to dismiss the struggles, pain, fear, and responsibilities a caregiver has is hurtful. Can I dance?... Yes, when my body isn't so riddled with pain from caring for my family or when I am not sick from the stress. This talk does no one good. I wouldn't be anywhere than by my husband's side and I am 100% sure he would be by my side if the tables were turned. I am sorry you had a stroke- I wish you didn't. Please be kind to those of us who love and support our survivors.
Sure -- I can dance. When I might actually have five minutes of someone else taking care of my husband - or when I"m not overwhelmed by fear and anxiety from everything that his strokes have changed. His strokes affected me in every single way -- just differently than him. We are all working through these struggles together -- survivors and caregivers.
We heard you loud and clear. Get what I'm saying?
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I thought that this group was for caregivers where we can vent freely. And no my husband and I can no longer dance. Ballroom dancing was once our favorite activity.
I thought only caregivers were allowed as well. Is there vetting that happens when someone wants to join? Admin?
Yes...It is true that I can still dance....but for me...where is the joy of the dance when the only person I want to dance with can not join me :(
Wow! Some days I wonder which one of us is worse off!
I just reread the informational post by Admin and it does say that Survivors are welcome but that if they are offended by what they read here, other sites may be more appropriate for them.
I think that makes it a little more uncomfortable for us when sharing our honest feelings and try to keep in mind there are Survivors here. 😕
Well that is one of the hard things about care giving, don't you your self be sick, feel bad, Overwhelmed, Exhausted, Depressed your self, Dead even though you are Alive, the Survivors make it ALL about them, sometimes a little self centered. If no one likes what they see on here don't come on! Just like my self centered husband gets on his sites see something that upsets him and takes it out on Everyone else I tell him STOP READING IT!! I can tell you one thing about care giving after So long and So much of it. You become hard sometimes because you get so Sick and Dam tired!
I can agree to what your saying. My husband has managed to become so manipulitave that is down right scary
It's not a contest about who has it harder. It's a completely different set of challenges for both. Trying to compare apples and oranges isn't going to help any.
Joyce Hoffman
Joyce Hoffman Yes, but it proves my point.
January 25 at 9:25

No it doesn't prove your point at all. It proves that your point is pointless.
I'm sorry, what was your point exactly? I'm not trying to be rude, I want to understand what you're saying. Speaking as a third party, I'm watching what my dad's strokes are doing to him, both physically and mentally, and I'm watching what the effects his strokes are having on my mom. I realize that all strokes are different, and that some are not as affected by their strokes as others, who may be extremely incapacitated. My dad isn't as badly affected physically as he could have been, which I'm grateful for. But as his caregiver, my mom is having to deal with a very difficult set of challenges, and it's very hard on her, both physically and emotionally. Please don't say that it's harder on one group than the other. It's not fair to either.

I usually just read posts here, and don't comment.
I am so sorry you suffer from a stroke.
But, feel you're out of line here.
Yes, our loved ones are suffering ....
They have no choice in that.
Caregivers CHOOSE to stay.
Choose to give all that they have
to care for, often unappreciated, and sometimes downright abusive, loved ones. Oh, and self-centered loved ones.

Liiike .. coming to a site for Caregivers to be about themselves for five goddamnit minutes of the day, and trying to throw guilt on them
Joyce Hoffman
Joyce Hoffman You are unhappy as a caregiver? So then why do you do it?
She never said unhappy...
Well, that posted before I could make corrections.
I'm sorry..
I should have kept quiet.
What cha sorry about? It's the truth. We as caregivers have no clue what the future holds for us when our loved ones come home from the hospital. Not everybody has a positive experience. Hugs and prayers for you and your doing more good than you realize
Yes caregivers can dance...but with who? Its a tough life altogether!
Joyce Hoffman
Joyce Hoffman Maybe I should have said peel potatoes.
husband has No movement on left side and cannot get himself up , gets tired and needs help eating ,sooo , After changing all day , bathing , feeding (food has to be blended) , medication ( has to be through g-tube),breathing treatments , brushing teeth , moving every so often, washing ( use a lot of wash clothes and towels and sheets , mopping to keep sanitary and fresh , I think I would rather collapse into bed........and I also take my mom and dad to appointments and cook and clean and look after them and I have a 13 year old ...
I have seen this happen z few times on this site, so much so I don't feel I can post about how I'm feeling, that's why I started another group for Partners of stroke survivors where we can feel free to say how we are feeling ask what we may think are silly questions without being judged, I won't post the name of the group but if you would kind to join please send me a personal message with friend request xx
Joyce Hoffman
Joyce Hoffman Why does someone "caregive" when there are options? Caregiving is only for special people who don't complain about it to other people.
So Joyce what are the other options you are talking about?
I'm"caregiver" to my 30 Yr old daughter
If by dance you mean be happy or at least content I say yes! It takes time and for me a relationship w God.
Take it one day at a time. I cried many days and nights but it be came less and less.
I try to find good in lil thing.
Best wishes too you.
Yes dance, dance, dance. It's great exercise in any form. I do it with my husband who is in bed and asked him to shake his shoulders because he was getting contracted and I like to see him smile. Dancing is for the soul and everyone should do it whenever they can. Express yourself even if it's a sad dance.
February 4 at 6:28pm
My post was in a metaphorical context. "You can still dance" shouldn't be taken literally. Some people in this group did. With my right side affected, I could have said lots of other things, like "You can still play the piano" or "You can still clap" or "You can still play golf."

Some pleaded for the Admin to step in and say something. Huh? If Facebook is a populist tool, why?

In response to that person who gave the first reply, don't bet on your spouse if the tables are turned. You may think that, but everybody processes caregiving differently. For example, my partner of 17 years couldn't take it 12 years into the relationship when I had a stroke, and rather than wait for him just to come out and say I should leave, I ultimately left to go to another city, with a driver and me traveling through a snowstorm with icy roads. All the inferences were there, like telling me about the woman a long time ago, a cancer patient, who lived in their house and all the resentment he had by losing his space, or imploring me to watch the movie Amour about two octogenarians where the wife had a stroke and the husband, who was the caregiver, contributed to her demise. I am happy without him. I think he is happy without me. I haven't talked to him in years. But I did him a favor. I don't like to see anybody struggling.

I wasn't keeping a scorecard of who had it worse. But just to be clear, the stroke survivor wins in that category. Some have lost their jobs, their pastimes. Some suffer from uncontrollable spasms, deep depression, mood swings. Strokes are a bitch. 

Mark Twain, amid conjecture, is often given credit this quote: You can be sure of two things in life: death and taxes. (Ugh. I know about the latter). But relating to the former, until you do die, there are options to any situation in terms of caring for a stroke patient. Listen up, caregivers. Take a break by having somebody--a neighbor, a family member--do the caring for a bit. Google your options of alternative places where the stroke patient could go for care permanently. You might be surprised at what you could find. But by no means, don't caregive and resent it. Don't play the victim role. Even though stroke survivors' brains were affected, they know. Trust me. They know.

Plus, caregivers can still dance. That's the bottom line, isn't it?

Jan 22, 2017

What Would YOU Do? aka Dumbass, Don't Squeeze By Me in the Hall in Order to Be First!

Should there be yet another protocol for the handicapped that includes a no passing zone? Read on. I really want to know your slant.

I was going for another blood test, my weekly routine (INR), to check if my blood coagulation was in an acceptable range because I take Coumadin, a blood thinner. (See The results got iffy for a while because I was slacking off, not always precisely counting the vitamin K that I get from foods like diabetics with their sugar. (Read INR tracker to see which foods are highest and lowest in vitamin K --

I had two appointments that day--blood testing and the neurologist at 4. It was now about 2 o'clock. As soon as I entered the building for the first appointment, my friend Jody and I, ambling faster by my standards but still slow by normal standards, went straight for about 25 feet and then made a left to travel about 100 feet down a narrow hallway.

At the end of the hallway was Labcorp, an all-purpose center for testing of bodily fluids. Anybody who goes the distance is going to Labcorp because it's the last door straight ahead.

As I got within 20 feet, I heard a noise behind me. I turned around, still walking forward which was stupid for risking a fall, and saw what I presumed was a mother and her teenaged daughter narrowing the distance. Then they were a foot behind me. I know because I smelled the strong odor of garlic on their breath. That smell made me hungry, reminding me I skipped lunch. But I digress.

Anyway, we were almost to the door--I'd say 3 feet--when the mother and daughter edged past us, walking sidewards to get to the door first.

"No," I screamed when they were at the doorway, "we were here first. Let me go first."

Without saying anything, the mother and teen entered Labcorp without holding the heavy door which slammed in front of me and signed in ahead of me. Jody opened the door and I was seething, but Jody gave me that look that says, "Calm down." I didn't care and went forward with the argument. Jody picked up a magazine, but I don't think she was reading it.

"That was rude of you to go ahead of me. You see the cane so obviously I'm disabled," I said, glaring when we were seated.

But the mother was on her cell phone, her eyes cast downward as if she wanted to concentrate on the call, and the teen returned my glare. I saw I was getting nowhere with these two.

I looked around for "No Cell Phones Allowed" signs, at times seen in medical offices, adding fuel to my argument, but there weren't any. And of course, the mother and teen were taken ahead of me.

When we left and got in the car, Jody didn't talk to me, so I imagine she was pissed off. That shouting incident was a week ago, and to remain friends, neither of us brought it up. I was punctual for the next appointment at the neurologist a half hour away, with 15 minutes to spare, but that's not the point.

So I come to you, dear reader, to say: You know my side, but was I right to demand being first or was I wrong to expect that outcome? Use the comment section to speak your mind. Or write me an email. Either way. After writing for more than 40 years, I can take rejection.

Jan 7, 2017

You Probably Won't Get 100% On This Quiz About Strokes

Just what you wanted--a quiz to start off the new year. (Just joking). But take the quiz anyway. Even stroke survivors may not get them all right, but I hope they do.

For all the people who didn't have a stroke, I'm providing this quiz not to scare you but rather to educate you and make you more aware of strokes and their effects. Did I succeed? Well, you tell me! Write the letter of the correct response for all 10, if you can. The answers are at the bottom of this post. Here goes:

1. The first one is easy. What happens to a majority of people when they get a stroke?
     a. The mouth droops.
     b. The words are slurred.
     c. The person has trouble walking.
     d. The person is confused.
     e. All of the above.

2. What happens to the tongue initially when somebody has a stroke in a majority of the cases?
     a. It recedes.
     b. It gets longer.
     c. It goes crooked when the person sticks it out.
     d. It locks in place.
     e. It vibrates. 

3. Someone in the United States has a stroke every 
     a. 45 seconds.
     b. 2 weeks.
     c. 3 days.
     d. 2 minutes.
     e. week.

4. A stroke occurs
     a. when a clot blocks the blood supply to the brain.
     b. when a blood vessel in the brain bursts.
     c. randomly without cause.
     d. only when people reach the age of 65 or older.
     e. with either a and b.

5. Some risk factors of getting a stroke are
    a. heredity.
    b. age.
    c. gender.
    d. just a and b.
    e. a, b, and c.

6. Ethnicity plays a role in stroke attacks in that
    a. African Americans have double the stroke rates of Caucasians in the U.S.
    b. Caucasians have double the stroke rates of African Americans in the U.S.
    c. Asians have double the stroke rates of African Americans in the U.S.
    d. African Americans have half the stroke rates of Caucasians in the U.S.
    e. Asians, African Americans, and Caucasians and in a 3-way tie for stroke
        in the U.S.

7. Strokes are more likely to happen to
    a. low-stress workers and poor education level.
    b. high-stress workers and high education level.
    c. high-stress workers and poor education level.
    d. low-stress workers and high education level.
    e. anyone.

8. Every year, how many people have strokes worldwide?
    a. 2 million
    b. 300,000
    c. 5 million
    d. 10,000
    e. 15 million

9. According to a prominent study, what percent of the people who recover from their first stroke will have another stroke within 5 years?
    a. 10 percent
    b. 25 percent
    c. 75 percent
    d. 90 percent
    e. 100 percent

10. A stroke occurs when the blood supply to part of the brain is suddenly interrupted by a clot (ischemic stroke) or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells (hemorrhagic stroke). According to these facts, the brain cells
     a. die and cannot be regenerated according to all studies.
     b. live regardless of the kind of stroke.
     c. are in an ongoing study at the Cleveland Clinic to determine whether they can be
         stimulated and improved.
     d. live or die, depending on your gender.
     e. live or die, depending on your age.

How did you do? Tell me in the Comments section under this post if you have time.


Answers: 1. e, 2. c, 3. a, 4. e, 5. e, 6. a, 7. c, 8. e, 9. b, 10. c

Dec 24, 2016

New Year's Resolutions for a Stroke Survivor...Again

All my successes in the almost eight years since that horrid day were just actions I took to make the world more aware of strokes. But the successes are insignificant now in my eyes, always attempting to seek out the "thing" that will take me to the last stage on the list in Elizabeth Kubler-Ross' On Death and Dying, the Five Stages of Grief--Acceptance.

But it's Acceptance that just won't come to me. Don't think I haven't tried. I wrote a book about the stroke--The Tales of a Stroke Patient. Not enough. I write a blog called the same name as the book. Not enough. I was leading a stroke support group in the hospital. Not enough. I spoke at various forums and medical facilities about strokes. Still not enough. When is it that I will "accept" the stroke? Maybe never.

So here am I again, the stroke survivor, with ten resolutions for the new year. Maybe this will lead me to Acceptance. My random forced optimism is just that, an effort to see if this post will get me there. So here are my resolutions, in no particular order except the last, the things I want to happen most:

10. I will continue to work on the novel that is purely fiction. I've never written fiction before and I find it a challenge. I only wrote non-fiction for the past 50 years--telling, teaching, informing, explaining, aka news stories, books, blogging, how-to technical manuals. By the way, that picture is accurate. I write one-handed now. (

9. I will continue to lose weight beyond what I lost so far, and it's a lot, but it's harder now that I am older and don't move around so much because of the stroke. I can't do any exercises that have me sit on the ground because I can't get up. Yes, there's the recumbent stationary bike that I use four or five times a week. And there's walking up the hill to the parking lot. But I'm determined and that's, in my opinion, the most important quality, not to mention lighter is better. (

8.  I will set the phone alarm and put it on "Snooze" so I will be forced to get up and take my Coumadin. ( I usually set the alarm to "Stop," but no more. The best way to take this blood thinner is to take it the same time every day. I've been having ups and downs on my INR, the test that determines clotting, but maybe this alarm set to "Snooze" will help. The alarm sound unnerves me!

7. I will stop pretending that I can change people, to fit them into the mold that is acceptable to me, aka kind, gentle, supportive. The ones who don't? Out of my life. ( People that are angry-spirited and controlling will continue being angry-spirited and controlling because they are satisfied with themselves and don't see a reason to change. People can only change if the "want" is there. Without it, the success rate is nil.

6. I will donate to Heifer International instead of buying gifts for holidays and birthdays from now on. The charity's mission statement is this: "Heifer International’s Global Impact Goal will be measured through a allow us to clearly measure the impact of our work to end global hunger and improve livelihoods." I just gave chicks to combat hunger. Pretty neat, huh? (

5. I will regulate my sleeping schedule to arise at the same time every day, even on weekends once the new year comes. My poor sleeping habits started in the 80s when I worked as a columnist for the Philadelphia Daily News. My ex-husband was no help with the kids, and I could only write when the children went to bed. So I got used to it, writing from 10 until 2 or 3 in the morning, with sometimes with 4 hours sleep. But no more. Now that I had a stroke, sleep is extremely necessary to support a healthy nervous system and a clear-thinking brain, or what's left of it. (

4. I won't worry what people think when I wear the same-styled  sneakers all the time. Those sneakers, said more eloquently as Hush Puppy Power Walkers, are not cool when I dress up, but so what? These shoes, which I have in three colors--taupe, white, and black--help me get from point A to point B. So if somebody thinks they're not appropriate, I won't care. I'm so grateful for ambulating at all!(

3. I won't be a shopaholic in 2017. There's nothing I need aside from food and drugstore stuff and random entertainment. I have enough clothes and (see previous) shoes. I used to get super-charged when I would go shopping before my stroke. But now it's tedious, stretching the functioning arm or leg to assist the other side. Bottom line: I have enough. (Here's an interesting article on shopaholics:

2. I won't give up. Too many stroke survivors do. But for me, the way I was raised, the way my parents wanted me to be, I have no choice. Strength is all I know. Life has thrown me some curves but nothing so severe as the stroke. The stroke ruined the 17-year relationship that falls under the category of "it was just a matter of time," challenged my chance of ever speaking well enough to be a professor once more, and destroyed my hope of ever working in the law firm again. And still, I am here, smiling, when those who don't know me wonder why. Sometimes I ask myself the same thing. But my strength rescues me, once again. (

1. My sons know the unconditional love I have for them, in 2017 and beyond. I wish them health, happiness, and peace in this new year. To my friends (you know who you are), who emotionally supported me, thank you greatly. And to my readers who now number over 300,000, I will always be grateful for the opportunity to educate, inspire, and mind-boggle you. This resolution is ongoing.

Christmas is Sunday and Hanukah begins Christmas Eve, but I want to get a head start on this post so Happy New Year to all!

Nov 28, 2016

Coumadin and Vitamin K: What the Hell Is Going On with My INR and Other Questions Along Similar Lines

George Gallup is a name everybody should know. He started the Gallup Poll, initially named the American Institute of Public Opinion, in 1935. He was famous, a year later, for predicting that Franklin Roosevelt would defeat Alf Landon in the U.S. presidential election, a noted contradiction to the well-respected Literary Digest magazine who sent out two million questionnaires and predicted that Landon would be the next president. 

Along similar lines, much like the Gallup poll, a study published in the Annals of Internal Medicine in 2013 quizzed a random population and revealed that half of all Americans use some form of vitamin supplementation. Vitamin sales nearly totaled a whopping $12 billion annually, including as many as two-thirds of older Americans, 50 and above, and those with higher levels of education. A line of demarcation exists between the docs who say that the overwhelming majority of vitamins are worthless and the docs who say they're valuable to increase functioning of body parts. I say, who knows. 

But one vitamin stands out above the rest for people taking Coumadin, the blood thinner: vitamin K. A little background first.

Overall, Warfarin (the generic Coumadin) is a pill that I take regularly for two possible reasons: to help prevent blood clots or to keep a clot from getting bigger. To validate that Warfarin is diligently  thinning your blood, it's important to eat about the same amount of vitamin K every day. 

Vitamin K normally helps your blood clot so breaks in the skin don't bleed as much. Warfarin works against vitamin K, making your blood clot more slowly. 

So Warfarin and vitamin K work against each other along the lines of a battle that no one should win. When you take Warfarin, as my PCP says, it's important that you eat the same amount of vitamin K every day. 

"If spinach is on sale at the Giant Eagle, don't eat more amounts than you're used to," says the PCP. (Spinach is high in vitamin K).

I was living in New Jersey for almost two decades with an ex-partner who was an opinionated eater, healthy but opinionated. I made every shopping list the same and soon I didn't need a list. After my stroke, the role shifted and my ex continued to buy the same things, healthy choices but the same choices. So my diet was well-controlled both before and after my stroke.

When I moved, I was on my own and that's when the troubles began. I soon realized, just like a diabetic has to count sugars and carbohydrates, I have to count my vitamin K input. I bought what I wanted and didn't know that I have to count. Now I know the secret.

If you already eat a lot of leafy green vegetables, that's all right. Just keep it about the same amount each day. And if you take a multivitamin that contains vitamin K, be sure you take it every day. If you start dieting to lose weight, always keep the doctor informed so that the Warfarin can be adjusted.


You're allowed 90 mcg (micrograms) of vitamin K every day. Notice the portion size and adjust accordingly. Here is a partial list, brought to you by WedMD:

Food (no salt added) Serving Size Vitamin K (mcg)
Kale, boiled, drained 1 cup 1062
Spinach, frozen, boiled, drained 1 cup 1027
Spinach, boiled, drained 1 cup 889
Collards, boiled, drained 1 cup 836
Broccoli, boiled, drained 1 cup 220
Brussels sprouts, boiled, drained 1 cup 218
Parsley, raw 10 sprigs 164
Cabbage, boiled, drained 1 cup 163
Spinach egg noodles, cooked, enriched 1 cup 162
Spinach, raw 1 cup 145
Broccoli, raw 1 cup 89
Lettuce, green leaf, raw 1 cup 71
Coleslaw, fast food ¾ cup 70
Okra, boiled, drained 1 cup 64
Green peas, canned, drained 1 cup 63
Lettuce (such as romaine), raw 1 cup 57
Vegetables, mixed, frozen, boiled, drained 1 cup 43
Lettuce, butterhead (such as Boston or Bibb), raw ¼ head 42
Blueberries, frozen, sweetened 1 cup 41
Peas, edible pods, boiled 1 cup 40
Green peas, frozen, boiled 1 cup 38
Tuna fish, light, in oil, drained 3 oz 37
Celery, raw 1 cup 35
Lettuce, iceberg, raw ¼ head 33
Soy beans (edamame), boiled 1 cup 33
Kiwi, raw 1 medium 31
Scallion or spring onion, raw 1 medium 31
Asparagus, boiled, drained 4 spears 30
Blackberries, raw 1 cup 29
Blueberries, raw 1 cup 28
Marinara sauce for pasta, ready-to-serve ½ cup 18
Cucumber, with peel, raw ¼ large 12
Canola oil 1 Tbsp 10
Olive oil 1 Tbsp 8
Pistachios, dry roasted, salt added 1 oz (47 nuts) 3.7
Tea, brewed, prepared with tap water 6 fl oz 0.0
(For more information on other foods and the amount of vitamin K in them, go to

If I didn't eat vitamin K at all for that day, I'd eat three kiwis equaling 90 mcg, which I always have on hand.

There are only three foods that I know of that I can't consume at all while I'm on Warfarin (I suspect for the rest of my life): cranberries, grapefruit, the latter in any form, and alcohol. (Farewell, rum fruitcake, my favorite food of all).

Check with the doc before you take any supplements or herbal products which may contain vitamin K.

To assess how well Warfarin is working, a blood test is needed every week or two to measure how long it takes for your blood to clot, until your blood result is stable.

Your lab results are called Prothrombin Time (PT) and International Normalized Ratio (INR) values. 

Your INR needs to be in a safe range--not too high to cause bleeding and not too low to cause clotting. Vitamin K can change how Warfarin works, which changes your INR. For me, and most people, the safety range is between 2.0 and 3.0. 

To summarize:
  • Vitamin K lowers your INR values. The lower your INR, the less time it takes for your blood to clot. A low INR means that warfarin isn't working well enough to prevent a dangerous blood clot.
  • Warfarin raises your INR values. The higher your INR, the more time it takes for your blood to clot. A high INR means that warfarin is working too well, so you bleed more quickly and easily which can be dangerous. 

And from INR Tracker ( You'll learn interesting things like 1 cup of granola has a little bit more than 10% of your daily Vitamin K needs. Or that you would have to eat 34 eggs to get 100% of your daily Vitamin K needs.
I'm moving toward stability by counting and eating the same amount of vitamin K daily. But it's like I always said: It's tough being a person.