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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.

Oct 4, 2015

Stroke Survivors Could Easily Handle a Power Nap. But Do They Want To?

Everyone feels tired at some point. But I fight napping. If I nap, even for 15 minutes, during the daytime, I'm hit with insomnia at night and go to sleep at 4am. It all started when I stayed up later and later to write this blog and other things.

Karl Doghramji, MD, Medical Director of the Sleep Disorders Center, Thomas Jefferson University, Philadelphia, reports, "The avoidance of naps has been proposed as a method of enhancing sleep continuity on the following night." 

Truer words were never uttered. When it comes to strokes specifically, The National Stroke Association (NSA) says that post-stroke fatigue, or PSF, affects as much as 70 percent of stroke survivors, especially in the early years. PSF happens without warning. PSF is not just feeling tired and wanting to take a nap. With PSF, you have to take a nap. 

The NSA identified 3 types of fatigue for stroke survivors:

Cognitive (like mental fatigue, difficulty focusing)

Physical (like function limitations, spasms, pain, muscular weakness, interrupted sleep)

Emotional (like crying and laughing at odd intervals,

I encountered all of them. On the cognitive 
side, even six years later, I still have mental fatigue and usually rest once a day; just resting, not necessarily napping. I have all of the physical ones randomly. As for emotional fatigue, I am still, somehow, motivated, but I cried and laughed at the wrong times and places the first few years. And depression? I still have it, though rarely, but doesn't everybody?

The top 10 foods, according to the NSA, that can help ward off fatigue include:

1.   Walnuts
2.   Pumpkin seeds

3.   Quinoa
4.   Yogurt
5.   Whole grains
6.   Wheat bran cereal
7.   Red bell peppers
8.   Tea
9.   Watermelon
10. Dark chocolate (Watch your intake and your waistline!)

I tried all of those on the list, but I'm back to insomnia again. 

According to strokeassociation.org, survivors expend more-than-normal energy to do everything.

“You may have less energy than before because of sleeping poorly, not getting enough exercise, poor nutrition, or the side effects of medicine. You have as much energy as before, but you’re using it differently because of the effects of your stroke. Things like dressing, talking, or walking take a lot more effort. Changes in thinking and memory take more concentration. You have to stay 'on alert' all the time--and this takes energy,” says the association. 

So if you fight napping and still have trouble with Circadian rythym, where you wake up later and your days go until 4am, for example, try these methods coming from UCLA's Sleep Disorders Center:
  • Poor sleep habits can also disrupt your sleep pattern. A sleep specialist can help you adjust your behavior to promote better sleep. Maybe you have sleep apnea.
  • Bright light therapy may help shift the circadian system and reset the body's clock. Properly timed exposure to bright light can help advance or delay the sleep cycle. The television or computer, for example, may interfere with bedtime because of the bright lights. 
  • Studies are exploring the use of melatonin supplements to treat circadian disorders. Melatonin is a natural hormone. Your body produces higher levels of it in the bloodstream at night. It is believed that melatonin helps signal your body to go to sleep. It may also play a role in resetting the biological clock. Talk to a doctor before taking melatonin. 
I want to join the world at 7am and go to bed at 11pm. But I'll conquer insomnia. It just takes time, the experts say, and that's the response I like the least.

Sep 19, 2015

Aging Gracefully, Dammit! aka I Can't Blame My Stroke on This One

Sarah Jessica Parker was the sex columnist, Carrie, in the television show "Sex and the City" and Shania Twain is the rockin' Country star and Kevin James is the hilarious comedian, but what do they all have in common? They've all turned 50 years old, (emphasis on "old"). How did that happen? They were 40, and then, in the blink of the eye (from my perspective), they've probably lived longer to date than they're going to live in the future.

I count myself among them because, at the age of 67, I am going into the sunset of the rest of my years and a senior citizen, and I, too, passed the midway point of life.

I hired a new aide who's 24-years-old. We were talking about her mother who's 51. She was saying when her mother and she walked into a store or restaurant, everybody who didn't know them thought her mother was her sister.

"She really looks young," she said, "and people can't believe she's that old." Old? She thinks 51 is old? I let that go, didn't go rogue or anything.

I look younger than I am, too, so I asked the aide, who already knew my age--67--what other people would guess my age to be.

She replied, "You don't look a day over 62." 62? I think I look late 40-ish, early 50's at the most. Maybe I am delusional. Or maybe my vision is poor. Her comment got me to thinking, "What's our obsession with age?"

In How to Overcome Age Obsession, Sanjay Gupta, CNN's Chief Medical Correspondent, writes, "If you think about it, whichever stage of life that you’re at, if you look back at the other stages, you will realize that you had a good time then but you probably will not want to go back there."

The Huffington Post reported on a segment of Today Show, Why Are We Obsessed With Looking Younger? where make-up artist Bobbi Brown says, "It's about resetting your brain. It's not about how you look; it's how you feel and how you think."

I say (this is the delusional part) that age is only a number, when I'm alone and trying to convince myself that age doesn't matter. But let's face it. We're one year older than the year before, which is why Jack Benny, when he celebrated his 39th birthday in 1933 on the radio air, stuck to that magical number for the next 41 years, no matter what his age really was.

It's not an original story. My mother gave me hell after I threw her a surprise 65th birthday party, and my cousin, Joseph, came up to her, according to my mother, and said, "Now we know how old you are." She was embarrassed and didn't talk to me for a week. She was age-obsessed, too.

You want to get a harsh reality check, to feel really old? Think about your kid's age. My older son is going to be 40 in January. My other son is going to be 35 in April. I can still remember the seemingly millions of stories, when Andy had to be rocked incessantly in the middle of the night when teething for every tooth, when Jordan climbed out of his crib at 11 months and landed on the floor at 4 am. 40 and 35? That's when the truth really sinks in.

There was a Bingo tourney in the community room of my apartment building yesterday. The 24-year-old aide asks, "Do you want to go? They're giving away a designer handbag."

"I detest Bingo," I reply. B-15. O-52. "I get shudders from the boredom," and from the age-related insult. (I always thought, Aren't most who play Bingo over 70?)

She goes on. "While you're playing Bingo, you could meet some of your neighbors in your home."

And there it was--"in your home." Let me tell you something about my "home." It isn't a home for the disabled even though I had a stroke. It's an apartment building, not an assisted living facility, already beginning to feel defensive about my age. And furthermore, I continued to myself, feeling my anger almost turn into rage, I don't like Michael Kors handbags with the MK highlighted all over the bag. I shuddered again. I realized I was going into topics she didn't even broach. And I knew, just knew, I was on the edge.

"I have an idea. Let's go shopping for a new I-phone case," I insisted, yearning to appear hip.

And shortly, I returned to the Verizon store, lost the anger, and was, in my mind, 48 again. 

Sep 3, 2015

5 Hilarious Thoughts about Campers and Stroke Survivors

J, a good friend, and I accomplished the 2-hour drive from my place to the campground in Ohio, stopping at Cabela's in West Virginia, the hunting, fishing, and outdoor gear emporium that also had bison burgers and deer meat custard if you wanted to take a break from shopping. (Only kidding about the custard). I bought a long-sleeved shirt because I didn't pack any and the air took on a chill even though, technically, it was still summer. Going to Cabela's put J even more in the mood for camping, but I just kept muttering that line to myself that Dorothy says in The Wizard of Oz: "There's no place like home."

J and I traveled the gravely, rutted road for one mile once we got off the highway and then we were there--Seneca Lake Resort--which was 300 lots filled with 300 trailers. This time was the first for me since my stroke 6 years ago that I agreed to go. It was a gargantuan step that took me out of my comfort zone of television, writing, and exercising in my own apartment. I was ready for the challenge.

As we pulled up to her trailer house, J had an addition--an attached, screened-in porch as do some of the people, and some people have ongoing projects--an extra bathroom in progress, a built-out kitchen soon to be completed, an almost expanded bedroom. And some people only have the original trailer. But all of the people enjoy camping. I mean, really enjoy camping.

I can't expect anybody who hasn't experienced a stroke to know, at exactly the point of our arrival, what dangers lie ahead. I hadn't fallen for over a year and yet I saw all that lay before me--a high step up to the screened porch, four  wooden steps to get into the trailer, throw rugs as my eye could visualize, a back deck with a high step, and 5 rocking, unstable recliners throughout the porch. But I had come this far and I wasn't going to renege. I just wasn't. I had to pee and it was a decision whether to go up those wooden steps or hold it in. (I held it in for a little while longer).

The weekend was great, but the challenges even more so. So I present the list: 5 Things You Have to Remember about Camping as a Stroke Survivor.

#1: Forget your fear of bugs. This is camping. The first time I saw a wasp in J's trailer, I thought life as I knew it was coming to an end. I'm allergic to anything "bee-like." Then my mother's words returned to me: "If you don't bother it, it won't bother you." My mother's words weren't at all true, but you have to forget about the flyin' and/or creepy crawlies when you go camping. You have to pretend that they're your friends. (Come to think of it, some of my friends have stung me, too, but I digress).

#2: Lose your fear of food. Sometimes, you just have to go with the flow. I am a picky eater. I eat the same things every day and only the combination varies: yogurt, bread, cheese, turkey, peas, bananas, and oatmeal. J served spicy-hot chili with meat one night, sausages with fried onions and peppers the next night. I ate sparingly, but not sparingly enough. No more information needed. 

And it was shocking  when J's husband, who has Southern roots, announced that dessert was boiled peanuts. I never had boiled peanuts and the thought of those little legumes jumping and sloshing around in scalding hot water made me sad. But after I tasted them, I was hooked and I didn't feel sorry for those peanuts anymore. I started thinking if boiled peanuts were offered on Amazon, the website where I should own stock in the company, I'd order them.

#3: Don't ever say, "Eeeew." We went fishing, just the three of us. Their son stayed with a friend and they were catching bugs to put into the ant farm that I bought him as a gift (also known as a child's self-created apocalypse. Beetles and ants? You can imagine). Anyway, I was sitting on the rocking boat and I was pretending that I wasn't sea sick, when all of a sudden, J's husband caught a big one--a flapping, pissed-off bass that was putting up a pretty good fight. 

After reeling it in, J said, "Here, you hold it by the line while I take a picture." There were a lot of things wrong with that picture, but at the top of the list is the fact that the fish, now going bonkers, was spraying lake water on my body. I was a little OCD now from my stroke, and once we returned from fishing, I couldn't take a shower after because the trailer's tub is too high, but I promised myself that I wouldn't say the "E" word even once, so I let the fish have his agony while she snapped a few pics. But that doesn't prevent me from saying it now, safely back in the comfort zone. EEEEEEEEW!

#4: Do what the other campers do. Mostly everybody had a golf cart on their property for visiting other campers or just snooping at the other 299 trailers to see what they had going on. I saw them going by, golf cart after golf cart, many of them driven by young kids. The park didn't care as long as your foot touched the pedal. J had a golf cart, too, and said she wanted to give me a tour of the park-like setting. The golf cart's speeds were "off" and "beyond-your-wildest-dreams-fast, aka "Indy 500-car fast." There were no seat belts, so her husband used a spare garden hose to keep me from falling out. That gesture really wasn't necessary because I wasn't going anywhere. Seeing the setup beforehand, I grabbed tight to the bar right behind J's head, and the garden hose belt fell off 50 feet from the trailer when we started. 

We were off! I kept me eyes open in a wide-eyed stare, waiting for my eventual death, going around sharp curves and hard bumps in the road, but after a few minutes, I enjoyed it. My hair was shot to shit because the golf cart didn't have a windshield either. But the amazing thing about all the campers we passed on that mini road trip is that they didn't care what I looked like. If you ever want to feel accepted, go camping. The reason? Everybody in the camp looks like shit, too.

#5: Relaxation is the key. For 3 days (except for the aforementioned), I was totally relaxed. I lay in the sun thinking only good thoughts. I sat in the recliner and saw, through the screened-in porch, scores of cardinals, hummingbirds, and yellow finches traveling to and fro to the 5 bird feeders, hanging from strings to keep them out of the raccoons' reach. I reclined by the fire pit and was thankful for J sharing this experience with me and the lily pads she pointed out on the lake, for J's husband who was all about safety, and J's nine-year-old son for offering to help me to traverse the flagstone walkway and showing me the frogs he caught (and let go). 

Soon as I got home, it was back to the same old, same old, but for 98% of the 3 days I was there, I had found nirvana.

Aug 8, 2015

Depression and Stroke, aka If It Comes to Depression, You Know What Hell Feels Like

I think of depression as an inverse proportion formula--the longer you live with the stroke, the shorter you think about depression. It was that way with me, but it isn't that way with everybody.  "P" says on Facebook, "I'm still depressed 20 years later. How come you're not?"

Well, "P," the last time I thought about depression was 2 days ago. The time before that? I don't know, but it wasn't much in the last 2 years. So what prompted my depressing thought? I'll tell you.

My personal assistant said, "Do you have to wear that brace forever?" But that comment, even though it was horribly depressing, didn't give me depression. It just gave me, for a fleeting moment, sad thoughts about all the things I couldn't do anymore, like tennis, square dance, run. But I didn't dwell too long on that thought--maybe 5 minutes at most--because what's the alternative?

Plus, depression comes in many forms:

Major Depression (5 or more symptoms for 2 weeks or longer--loss of interest in your activities, sleep problems, weight fluctuations, energy level changes, feelings of guilt, trouble concentrating, thoughts of suicide)

Dysthymia (2% of people have it for a year which can be indicated by low mood  sadness, trouble concentrating, fatigue, and changes in sleep habits and/or appetite)

Bipolar Disorder (patterns of excessive highs and lows)

Seasonal Affective Disorder also known as SAD (most often during winter when the days grow shorter and less sunlight is available)

Psychotic Depression (seeing or hearing things that aren't there, incorrectly believing that others are trying to harm you)

Postpartum Depression (comes right after childbirth, lasting a week or even months)

Premenstrual Dysphoric Disorder (once-a month mood swings, trouble concentrating, irritability)

'Situational' Depression (death, divorce, financial woes)

Atypical Depression (increased appetite, sleeping more than usual, arms and legs heaviness, overly sensitive to criticism, all of which a positive event can temporarily improve mood)

If you recognize depression in yourself or others, and you or others want to get help, there is help available. (The operative word is want). Talk therapy and drugs help, but only if you want it. I can't stress "the want" enough.

Three of many studies about depression that caught my eye appeared in the Journal of the American Heart Association:

So those findings helped me to generate ideas.

1. Rehab therapists, on the whole, don't give reasons why you're batting the foam ball, why you're putting round pegs in round holes, why you're standing up and sitting down with 10 reps and 2 sets.

If they took time to explain why you're doing those things, maybe stroke survivors would realize the importance, not just silly games to waste time, to try and decrease or even eliminate depression.  

Sometimes, therapists don't listen. I heard them talking. They're more concerned with the schedule (oh, God, I have 3 more patients to see) and the order of the room (I must return the ball to the basket) than they are with explanations (the exercise I am asking you to do will improve your balance, endurance, your future life!)

2. Our no-nothing Congress should pass a law (yeah, that's gonna happen) that there should be a psychiatrist or psychologist or a licensed social worker in those first weeks or months in the rehab center after the stroke to avoid depression and regularly see patients and scare them "straight" into rehabbing all they can, by telling them "do you want to have a hand and foot that are dead?" or "you have to try and pronounce each syllable. TRY!"

For me, it would have made all the difference from keeping me in Hell, aka depression, for those first years. Then I went to talk therapy. Fortunately, I was only a visitor in Hell and I got out. But I wanted to escape the torments of depression. 

Remember what I said earlier? I can't stress "the want" enough.

Jul 26, 2015

Wheelchairs and Stroke Survivors, aka Talk to Me When You're Talking to Me

China had the first-recorded wheelchair in the 6th century, made of plant reeds and iron wheels, and then Spain, Germany, and England later, ably transported, mostly through wars, the disabled by other wheelchair materials. Many centuries later in the 1700s, in Bath, England, the most popular wheelchair, albeit cumbersome, looked like this: 

Now we have this


Look how far we've come. But I'm here to talk about wheelchairs in a different capacity.


There are two Mark Zupan's. There is Mark Zupan, the famous dean of the University of Rochester's Simon School of Business, but I'm talking about the other Mark Zupan, who earned a soccer scholarship to Florida Atlantic University


Mark Zupan

A football and soccer star in high school, and after a soccer game in '93, when he was 18 years young, Zupan got buzzed at a bar along with some of his soccer team and fell asleep in the back of his friend's truck. His friend, driving drunk, went off the road and Zupan landed in the canal, clinging to a branch for almost 15 hours, resulting in hypothermia and, ultimately, to quadriplegia.  


Even though he stands and walks short distances, Zupan ended up in a wheelchair for life and became a quad rugby champion twice. Zupan went on to become a TV and movie personality, appearing many times as "the guy in the wheelchair."  


Zupan's autobiography, "GIMP: When Life Deals You a Crappy Hand, You Can Fold---or You Can Play" and his notable championships make him famous.

But to me, he is most famous for his words: "We're normal people," says Zupan. "Don't be scared because we are in a chair. People don't understand that. They think, 'Oh, a wheelchair, something's wrong with their heads, something's just not right.' Well yeah, we may be a little twisted, but no more than anyone else." And there it is: "no more than anyone else." 

Maybe it's only me, feeling diminished by the wheelchair. I can stand and walk with a quad cane so sometimes, when I'm in the wheelchair, I raise the leg rests and stand so I'm on the same plain as everybody else. I'll explain.

When I go to a doctor or a store and I have a lot of walking to do, I'll go in the wheelchair, of course with a friend because I can't drive (seizures in the first year, and this is my 6th, but still...). The doctor or the salesperson always addresses my friend, like, as Zupan says, they think "something's wrong" with my head.

I was almost to the point, many times, of telling them "to look the fuck at me." But I didn't. Except one time. I was, to use on old expression, at my wit's end.

Kristin C, working with the elderly, says in an email, when looking at somebody in a wheelchair: "I think we can only learn this from exposure to [the wheelchair]. If we all realize that it is the person in the wheelchair who counts, and not the wheelchair, and actually look at the person, we will get better at it from practicing it."

But how many people do that? 10 percent? Less? Fuck. Not many at all.

Now I have a new line, much more genteel, to redirect attention back to me: "Talk to me when you're talking to me." You can use it for the doctor or salesperson. If asked, say you just thought of it. Don't say you read it somewhere. Don't give me credit. Just use it. And it works every time.

Jul 10, 2015

For Immediate Attention: An Email Just Received

I just received an email from Douglas Lowell, President of Find a Cure Panel for debilitating diseases including stroke. Here is what he said:

Subject line: Cryptogenic stroke (which is known as a stroke of unknown cause) qualitative research

Find a Cure Panel specializes in patient research for rare and serious diseases and conditions including strokes.

Douglas Lowell says, "Patients who have no idea what caused the stroke and the doctor lists 15 reasons but can’t settle on one, and nobody agrees…that’s cryptogenic and as long as they do not have AFIB, then they qualify."

In the next few weeks, FACP has some patient and caregiver research for people who have suffered a cryptogenic stroke (which is also known as a stroke of unknown cause) but have NOT been diagnosed with AFIB.

It’s very easy to participate. It’s one confidential and anonymous call with one moderator talking about your experience. FACP gives you a 1800 number to call in and schedule the call at your convenience.

To qualify:
1) You must live in the US;

2) You must have suffered a cryptogenic stroke (stroke of unknown cause)

3) You must be over the age of 50

4) You must NOT have an implanted cardiac device (ie. Monitor or pacemaker)

5) You must NOT have been diagnosed with AFIB

6) Must NOT be using Veteran’s insurance.

If you do the call, FACP will donate $100 to a non profit of respondent choice.

If you are interested in participating, please email us at info@findacurepanel.com and reference cryptogenic stroke.

As my grandmother used to say in her broken English, "Oy. It couldn't hurt."

Jul 8, 2015

10 Things I Learned About Living as a Stroke Survivor

I live a life of peacefulness. I'm not rich and don't want to be. I am a Goodwill addict. And I've never accepted the stroke fully, but I'm close, getting to recognize that I am competing with myself--one more step to climb, yet another minute on the bike, an additional hour standing.

I have solitude now, but I'm not lonely. When it's quiet in my apartment, I am thinking all the time--of this blog, another book to read, another book to write. And the ten things I learned about living as a stroke survivor. Here they are:

1.  I find people staring at me, like an oddity of sorts among the "normals." I used to return their stare, angry and maniacal, but now, I like myself enough to not care.

2.  I'm worthwhile, making a contribution, albeit small, to society at large, by giving my knowledge about strokes to anybody who affords me the opportunity to speak. There is always a stroke group who loves to hear the stories behind a stroke survivorship.

3.  I pursue my love of reading to keep my brain at optimum level. If my eyes tire and can't read the words on the page, I use audiotapes.

4.  I always use the computer since I am a writer. But you don't have to be a writer to stay in touch with the world via the computer, with CNN or Google news, for example. My iPhone and my iPad do the same thing. 

5.  The last cry for help was the last. Having Life Alert, a direct connection to the emergency crew by pushing a button on a necklace that's always around my neck, makes me and my sons more comfortable. The cell phone, if it's charged, works the same by calling "911." (The operative word is "charged"!)

6.  Most of my falls were in my kitchen. But now, I bought a used wheelchair and a new cushion that I keep in my kitchen to prevent falling--sit, retrieve, and stand.

7.  I speak from the gut now to medical professionals, telling them, for example, if they missed a question on the "new patient" form or if they don't let me finish my thought, always preceded by, "With all due respect...."

8.  I like to be organized to simplify my life and to accommodate all my OCD (which many stroke survivors have) tendencies. So I have a file cabinet and a desk which I bought at Goodwill for $15.

9.  I set the alarm on my iPhone when I have to take medication by speaking to Siri, the intelligent personal assistant that comes with Apple products. It takes the guesswork out of remembering. I also set the alarm to keep from napping longer to avoid insomnia at night.

10. I live each day with appreciation for the love of my sons, their respective significant others, and the friends I have obtained coast-to-coast in America and around the world.

As I say in the intro to the blog, "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." 

I am here, alive, and trying my damnedest to keep it that way for a long time.

Jun 21, 2015

The Relationship Between Surgical Procedures and Blood Clots

Wake-up time. If you're going to have surgery in the near or distant future, please read this post. As common, a little history first.  

Blood clot
Blood clots are a solemn reminder of just how fragile the human body is. Blood clots usually appear in your legs and are called deep vein thrombosis (DVT), the most common type of blood clot after surgery. They typically remain in the legs, but can break free and begin to move through the blood stream, like to the lungs or brain, known as an embolism. I had two blood clot experiences as a stroke survivor, and with both, the hospital kept me for a week each time. You might think that doctors and nurses are obsessed by blood clots, but this event is serious business. And the obsession is valid.

Blood clots can lead to a stroke, another name for an embolism that travels to the brain. Strokes can result in long-term disabilities including
slurred speech, an inability to speak, one-sided weakness, and facial drooping, for example. 

Pulmonary embolism
A pulmonary embolism means one clot landed up in your lungs, causing possible pain and severe shortness of breath, resulting in death for 30%.   

Clots are often associated with surgery. The reason is, the person is lying still during the procedure and potentially for many hours post-surgery. (Blood clots, as mentioned in my blog, can also form when an person is motionless for long periods of time, such as during airplane ride a long car trip. http://stroketales.blogspot.com/search?updated-min=2013-07-01T00:00:00-04:00&updated-max=2013-08-01T00:00:00-04:00&max-results=2)

The type of surgery you are having can also increase the risk of having blood clots after the procedure. If your surgery requires your arteries, veins, or tendons to be cut or repaired, the risk of a blood clot is higher because your body works to stop bleeding by forming clots. 

The risk factors for blood clots both during and after surgery may include:
  • History of Blood Clots: If you have had a blood clot in the past, your are more likely to have one in the future.  
  • Genetics: If your family is prone to clots, you may be, too. 
  • Atrial Fibrillation: Patients with an irregular heart beat have an increased risk of forming blood clots.
  • Pregnancy: The chance of blood clots increase as the body makes blood clot faster in preparation for child birth.
  • Cancer: Some types of cancer make blood clot more easily.
  • Hormone Replacement Therapy (HRT): One known side effect of HRT is the increased risk of forming blood clots.
  • Obesity
  • Smoking
  • Prolonged Immobility which include the time during anesthesia and recovering
  • Heart Valve Issues people with replacement heart valves or heart valve problems have a higher risk of forming clots that can then travel to the lungs or brain.

After surgery, if you are able, get up and move during your recovery, one of the ways to prevent blood clots. Staying well hydrated by drinking ample amounts of water can also reduce your risk of forming clots, too.  

One treatment for blood clots post surgery is heparin, a medication that is given by injection or by IV to prevent the formation of clots, to reduce the clots that already formed, or to keep the blood clots from getting larger. Another is Coumadin, or the generic Warfarin, given to help the body remove a clot from the bloodstream.

In cases where there is a high risk of the clot moving to the lungs or brain, especially after surgery, a device called an inferior vena cava filter (or Greenfield Filter) may be placed, which acts like a tiny porous vessel, catching clots before they can damage the lungs or brain. A small incision in the groin or neck is how the filter is put into place in the inferior vena cava. But the blood clots can break off and go to your lungs or brain anyway. That is how I had a pulmonary embolism. The filter can catch all, but sometimes not everything.

So you really have to hope for the best because the cold truth is, you never know what's gonna bite you in the ass next.

Jun 6, 2015

Walmart--A Convenient Place to Shop, Unless You're a Shoplifter

As a stroke survivor, I always feel vulnerable. I can't escape  from danger because I can't run away--from a fire, a mugging, or even a bee attack, for instance. As a result, I evoke unsolicited drama wherever I go. So it's time to tell you the story of when we went to Walmart.

Walmart, especially the super-sized ones, is the place you go when you need a variety of things, a consolidation of the trips you would have taken to the grocery store, the hardware emporium, and the plant shop, for example.

A couple of days ago, I (in my wheelchair because sometimes the scooters are wet from I-don't-know-what but I can take a guess) and my friend went to Walmart wearing casual clothing--the two of us in jeans and hoodies (my hoodie comes into play later on)--to shop for a bag of romaine, light bulbs, and a plant not requiring much of anything, like water and sunlight. But every time I go there, I get what's on the list and a slew of more items. Every time. Good marketing, I imagine.

Anyway, I also picked up an avocado and a box of tomatoes that an AARP article nudged me to do, a sun hat (which I didn't at all need), flip-flops for the future even though I still have an AFO, an extra extra jar of Musselman's  applesauce, just-in-case, that I use for taking my pills, a can of Pledge, two dust cloths (that are related to the Pledge), and two plants in case one of them dropped dead on the ride home. I also picked up batteries for my MP3 player that I use for exercising. My friend picked up a plastic container of Hershey's syrup that her son loved for chocolate milk.

The ride through the store was a hard one, going down every aisle in case I missed something, especially the sale items which Walmart calls "rollbacks." After a while, I couldn't carry the things on my lap anymore, after dropping the Hershey's syrup and Pledge three times. So my friend put the dropped items in my hood and we went to the cashier to check out. I got the receipt and attempted to exit the store.

However, I was in a high-anxiety state when extraordinarily loud alarm bells and buzzers started going off simultaneously. Soon, two beefy security men appeared. My friend (soon to be not) forgot to take out the Hershey's syrup and Pledge from my hood unknowingly. Really. Unknowingly! Evidently, Walmart has cameras, or security people watching from above.

Could it just prove my theory: You never know what will bite you in the ass next? I closed my eyes, expecting the worse, thinking to myself in the wheelchair, "Where am I exactly going? Could I run away? NO way!" My friend was standing alongside me.

"You have something in your hood," one of the guards said to me. It wasn't the time for jokes, but actually I had two things in my hood.

"Oh? I didn't know," I replied with all the self-righteousness I could muster. And I didn't know. She and I forgot about the allegedly stolen items. Because that's what they were. Allegedly stolen. Good thing the guards stopped us inside the store. I don't want to even think about what could've happened if we were outside the store.

I offered to pay for them and the two guards were looking at us skeptically with we-don't-give-away-free-stuff-at-Walmart expressions. Not a word from the guards any more. Without looking back, we just turned around, went to a cashier, and paid--me for the bulk of the items and her for the Hershey's. 

We didn't say a word during the long drive home. I was proud of myself for not saying, "She did it. It was her fault." And she was probably saying to herself, "Why do I even work for this woman." 

I found this article the next day on the computer:

Fort Lee, FL--A security guard at a Fort Myers Walmart was caught on video tackling a suspected shoplifter and holding her down. That employee has since been fired for how he handled the situation.

That worker told investigators he tried to stop them and they took off running. That's when he tackled them.

If that's the way Walmart's security guards were trained, were we lucky in retrospect? Absolutely!

May 17, 2015

Falls and Stroke Survivors: 5 Studies in 5 Continents, and 5 of My Tips for Preventing Falls

I'm out of the hospital. The reason I was in there at all for two weeks is because of blood clots--in my leg (DVT) and lung (pulmonary embolism, PE as an acronym). 

No matter what you call it, I feel like a ticking time bomb, never knowing if the time will come where another clot ultimately goes to my brain, and it's lights out--permanently. The docs assured me that wouldn't happen, but who knows? It's just the docs' educated guesses, one after another. I have an educated guess, too. I may be fucked.

A stroke survivor
So to take my mind off death, for the moment, I started to research falls as related to stroke survivors. Between 40 to 70% of stroke survivors worldwide have serious falls within a year of their stroke. I had many falls, most my own fault out of chancy stupidity and a few not. Here's some of my favorite findings, from 5 of the 7 continents. South America has an excuse. (And is anybody even living in Antarctica?) All continents used international and certifiable scales as related to stroke survivors and the falls they encountered.


Focus: Improving walking and reducing falls post-stroke

Background: California researchers understood that better comprehension of falls was imperative, as broken bones, hips the most common, and head trauma might be the result. 

So ambulatory stroke survivors were enrolled in Locomotor Experience Applied Post Stroke (LEAPS) and were assessed 2 months post-stroke. Falls were assessed for 12 months post-stroke and participants were characterized as: multiple or injurious (M/I); single, non-injurious (S/NI); or non-fallers. 

Results: The results were alarming. Among the 408 participants, 36%  were M/I, 21% S/NI, and 43% non-fallers. A majority of falls occurred at home in the first 3 months. Although multiple fallers are not at higher risk for injury for any given fall, cumulative injury risk increases with each fall. Thus, falls prediction and management for individuals post-stroke should focus on multiple falls.

A primary goal of stroke rehabilitation is to improve individuals’ mobility in the presence of motor, balance, and visual-spatial deficits. Yet, increasing mobility and physical activity increases exposure to fall risks. A review of exercise in older people strongly implies that strength and balance exercises reduce falls, whereas walking training alone may increase them.

Participants were assigned to one of three groups:
* a locomotor training program (LTP) that included use of the treadmill followed by walking practice 2 months post-stroke
* a progressive strength and balance exercise program provided by a physical therapist in the home started 2 months post-stroke.  
* late LTP, 6-months post-stroke

Each program was provided for 36 sessions over 16 weeks and was monitored between 2 and 12 months post-stroke. The researchers defined a fall as, “A person has a fall if they end up on the ground or floor when they did not expect to. Most often a fall starts while a person is on their feet, but a fall could also start from a chair or bed. If a person ends up on the ground, either on their knees, their belly, their side, their bottom, or their back, they have had a fall."

Of individuals who fell, 74% had at least one fall from which they could not get up independently. Fall rate per person year was 1.76 overall, 1.33 for moderately impaired walkers, and 2.13 for severely impaired walkers. But here's the thing: Of the three groups, there was no difference in overall fall incidence between 2 and 12 months post-stroke. And between 2 and 6-months post-stroke, both groups receiving early intervention had a higher fall rate than individuals in the late-LTP group. Over-confidence, the researchers theorized.

Focus: Falls in older adults with strokes

Background: This Australian study aimed at two things: probe the  differences in the incidence of falls between chronic stroke subjects and matched non-stroke subjects who were 65 years or older and community dwellers, and establishing factors associated with falling with chronic stroke survivors.

Results: More stroke survivors reported falling in the previous twelve months after the stroke than non-stroke subjects (36% vs 24%). When comparing stroke survivors who fell to stroke survivors without any falls, the first group were more likely to report to have difficulty in stooping or kneeling, getting up in the night to urinate more than once, and having a greater problem with activities that involved hygiene, that is, bathing or showering.





Focus: Risk factors and management in stroke survivors who have fallen

Background: Israeli researchers found that falls are common events among hospital inpatients and constitute a major health problem in rehabilitation. Many risk factors for stroke falls such as muscle weakness, hypotension, and medication side effects have been identified.

Results: In a 5-year study of 56 falls in 41 stroke patients hospitalized for rehabilitation, 30 patients fell once, 9 patients twice and 2 patients four times, obtained from the medical and nursing records.
Most falls occurred among male patients who had reduced muscular tone (70%), paralysis (54%) and/or hemiparesis (one-sided body weakness). In addition, 48% percent of the falls occurring during the first month, 70% during the morning or the afternoon, and 62% occurred close to the patient's bed.
Also, 89% of stroke survivors' falls were attributed to medication side effects, 29% to communication disorders, 21% to blindness, and 18% visual sensory disorders.


Focus: Patient Falls in Stroke Rehabilitation

Background: Falling is a major complication in stroke rehabilitation. This study intends to investigate the incidence, characteristics, and consequences of falls in an in-patient stroke rehabilitation setting.

Precisely 161 patients were admitted to a geriatric stroke rehabilitation unit. Falls that occurred during their stay were registered and analyzed. The study was performed at the stroke rehabilitation unit of the geriatric clinic at UmeƄ University Hospital, Sweden. This unit is a 24-bed ward that specializes in stroke care and rehabilitation; patients are usually admitted from acute-care clinics 2 to 4 weeks after their strokes.

Results: 62 of the patients (39%) suffered falls. The total number of falls was 153, which corresponds to an incidence rate of 159 falls per 10,000 patient days. Most falls occurred during transfers or from sitting in a wheelchair or on some other kind of furniture. 17 falls (11%) were classified as the result of extrinsic mechanisms, 49 (32%) were intrinsic falls, 39 (25%) occurred in a sitting or lying position, and 48 falls (31%) remained unclassified. No injury was observed in 109 of 153 incidents (71%), whereas 6 falls (4%) involved fractures or other serious injury.

(Per the above: For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants).

Focus: Gait and balance performance of stroke survivors in South Western Nigeria

Background: Stroke survivors are often left with neurological and functional deficits, which impair their ability to walk and affect their balance. This study assessed gait parameters and balance performance among stroke survivors.

Results: Seventy stroke survivors (65% males) who were 6 months or more post stroke participated in this study. The gait of participants was assessed by gait speed and cadence (rhythmic flow). Balance performance was assessed using the Activities-specific Balance Confidence scale for balance self-efficacy and Functional Reach Test for standing balance.

Participants were 43 to 65 years in age. Forty five (64%) stroke survivors had hemorrhagic strokes while 25 (36%) had ischemic stroke. There were significant relationships between gait speed and balance self-efficacy and between cadence and functional reach distance.

The study concluded that stroke survivors with higher cadences had higher functional reach distances, and those with higher gait speeds had better balance.

About 35% of survivors with initial paralysis of the leg do not regain useful walking function, and 25% of all survivors are unable to walk without full physical assistance. They also demonstrate postural control problems such as loss of anticipatory activation during voluntary movements, increased sway during quiet standing, especially on the affected side, and decreased area of stability during weight shifting while standing.

Postural balance is closely related to gait ability. A strong relationship has been reported between gait velocity and dynamic balance in the acute rehabilitation period among patients with first time stroke. 

"We did not find significant differences in the gait speed and cadence between fallers and non-fallers, though the non-fallers had higher gait speed and cadence values. The reason for this result may be because all our participants could ambulate independently and therefore had similar gait speeds and balance performance," say the researchers.

Stroke survivors with higher cadences had higher functional reach distances, and those with higher gait speeds had better balance. This implies that gait speed and cadence are factors related to balance performance and should be considered during balance and gait retraining.


There should have been 6 continents in my review about falls and stroke survivors, but The American Heart Association says the following about South America:

"Current knowledge of stroke risk factors and epidemiology is
based mostly on North American or European studies; so scarce data have been published from developing countries. Stroke will be a public health problem in South America during the next decades because of an increase in life expectancy and changes in the lifestyle of the population. Because epidemiological and clinical characteristics of stroke vary according to environmental, racial, and socio-cultural factors, we need to be aware of the peculiarities of stroke on 
this continent to reduce the impact burden of this epidemic."

Preventing Falls 
These are my new ways to go about preventing falls. I tried all of them and I haven't had any falls in a year since I began implementing these tips:
  • Use nightlights in bedrooms, bathrooms and hallways. If the light bothers your eyes, wear a mask. I don't. I deal with it. But either way.
  • Sit on a bench or stool with a handle in the shower and use a hand-held showerhead.
  • Secure area rugs with double-sided tape.
  • Review medications with your doctor as some may cause dizziness and balance problems.
  • Slow down and take all the time you need when walking. There is no need to hurry, and it may be safer to go more slowly. By the way, since most of my falls were in the kitchen, bending over to pick up something that landed me on the floor, I bought a used wheelchair, got a new cushion, and always use it when I've dropped something on the floor. I sit, retrieve, and stand. So much easier!
Granted, all strokes suck, but falling compounds strokes, like broken hips or bleeding heads. Keep that in mind.