David Letterman, New Year's Resolutions for a Stroke Survivor, and Other Things

It's New Year's Eve, for cryin' out loud. It seems I'm all over the place, but wait a minute. I promise focus.

David Letterman is a funny man. And "The Top Ten" lists don't hurt his image. Beginning in 1985 with "The Top Ten Things That Almost Rhyme With Peas," the lists still go on today. I'll wait for a promo of "The Top Ten," and if they're going to be on the show, I'll plan to watch them, but fatigue overtakes me sometimes and sleep is my go-to activity.

Anyway, almost 30 years later from "The Top Ten" inception, I decided to do my own, and these are my "Top Ten New Year's Resolutions for 2014," from this stroke survivor, in reverse order, inspired by Letterman:

10. I will accept the re-birthday expression that a lot of stroke survivors say even though I don't get it.

  9. I won't demean doctors in front of other people, but when I get them alone, watch out if they deserve it.
  8. I won't even think about going to Black Friday again.
  7. I will argue endlessly with therapists if they say my window for improvement closed after the first year.
  6. I promise to laugh at least once a day, because sadness all the time is counterproductive.
  5. I will support medical marijuana for pain always even though I don't use it.
  4. I won't abandon my pantiliners, just in case.
  3. I will never say "I had a fuckin'stroke" again, even when I'm frustrated.
  2. I will endorse people writing their stroke stories, too, even though it means competition.

And here's the number one of my stroke resolutions:
  1. I will always be grateful when I wake up to a new day.

So at the year's end, here's where I am, recovery-wise, after almost five years. I take bigger strides than I did before, using my lifeline, my quad cane. My arm is hemiplegic --paralyzed-- but I am getting back some shoulder movement that I didn't have before. I don't want to kill myself as I did right after the stroke that lasted, on the self-extermination issue, for one year. I don't have PLC --pathological laughing and crying-- anymore. All told, I'm better. But I have a long way to go. On the other hand, where am I going anyway?

Right before the year's end, I want to give a shout out to Ricky Brown for his blog, http://www.apoplectic.me. Even though his first name doesn't look like it, from an American's point of view, Ricky is Scottish and currently resides in Edinborough. He is very committed to stroke and recovery. If he ever returns to the states, I'll go to Brooklyn, his old haunt, to meet him. Thank you, Ricky, for sharing. And last but not least, I want to give kudos for Amy Shissler's blog, http://mycerebellarstrokerecovery.com. She offers many useful insights to stroke recovery. There are many more stroke blogs too numerous to mention. Google "stroke blog" and see what comes up!

And one last announcement: This is from Dr. Mario Trucillo of the American Recall Center, a brand new medical information site aimed at bringing consumers the most up-to-date FDA information in easy to understand, plain language terms.

"After suffering a stroke, one can easily become overwhelmed with questions about what comes next. From types of care are to prescription safety, caregivers and survivors are tasked with the responsibility of finding answers, without a clear solution on where to go first. The American Recall Center aims to make that easier.

"Our site provides news and safety alerts covering an expansive variety, from prescription drugs to hip replacements. Our goal is to take the wordy news and breakthroughs from the FDA and put them in plain-language, giving patients necessary information before they visit the doctor about their health and prescription drugs. It is our mission to empower individuals with trustworthy and easily-accessible information.

"A new feature that I’m especially proud to introduce is Patient Safety Alerts, a customizable notification system that sends updates to your inbox on the drugs that directly affect you. With this feature, you can check off the drug or medical device categories taken by you or someone you care for, and whenever the FDA issues a safety update on a drug/device in that category we will send you an update in our signature easy-to-understand terms. Save time and stress by signing up for Patient Safety Alerts and never worry about finding out about a recalled or unsafe drug too late again."

And this announcement is from me: Be safe and don't drink and drive in close proximity to each other. Happy New Year to all!

Black Friday Madness for a Stroke Survivor, aka Am I Crazy or What?

In 2011, The Huffington Post reported this story: "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. Friends and co-workers, saddened to learn of his death, expressed outrage over the way he was treated by shoppers. Lynne Vance [Walter's wife] said six nurses shopping in the store came to her husband's rescue and performed CPR until paramedics arrived."

This wasn't the only incident to put America's biggest shopping day in a bad light. There were more, and these are some of the horrific

highlights: In 2006, a man shopping at Best Buy was recorded on video assaulting another shopper. In the same year, raucous Walmart shoppers at a store outside Columbus, Ohio, quickly poured in the doors when the store opened, plastering a few employees against stacks of merchandise. When the crowd rushed to grab gift certificates that had been trickled down from the ceiling, nine shoppers in a California mall were injured, including an old woman who had to be rushed to the hospital.

In 2008, two people were fatally shot during a fight at a Toys 'r Us in Palm Desert, California. In 2010, a Wisconsin woman was arrested as she cut into the line outside of a Toys 'R' Us store, and threatening to shoot other shoppers who tried to voice their opinion. On Black Friday 2012, two people were shot outside a Wal-Mart in Florida during a dispute over a parking space. I remember those incidents and more.

Every year, Black Friday (the term originated in Philadelphia) inches a little closer to exterminating Thanksgiving by the stores opening earlier and earlier, taking a bigger bite out of Thanksgiving. I mean, THANKSGIVING, that wonderful time of year when the whole family gets together to show off their kids and tell everybody how prosperous their lives are. (At least, it was so in my family). It's all a sham, but don't mess with tradition. Traditions are what keeps families together, at least according to the advertisements.

We once went to Black Friday while we were visiting my son in Pittsburgh. We arrived, my son from Boston and I, at a Best Buy store
at around 3 am. The store was opening at 6 am. The one from Pittsburgh said we were nuts to go. We stood out there in sub-freezing temperatures to buy a bargain GPS. But, hey, Black Friday has come to be a tradition, too. But with all that pushing and shoving once the store opened, I vowed I would never go again.

That was ten years ago. And now, I had a stroke to contend with, but I never go out alone and it was 11 am. I thought about Black Friday again as I was going to get my nails done, not the death of the pharmacist but Black Friday in general.

"Hey! I always love a great challenge! Do you want to stop by the mall on the way to just see what everybody's buying?" I asked.

My aide looked at me, and her look wasn't at all good.

"Really? You want to go shopping with those lunatics?"

I didn't have to be a rocket scientist to know what she was thinking.

We were now two blocks away from the mall.

"'I'm just sayin'. I want to go in and get the experience all over again." I was in the mood to do, not think.

This time, the aide didn't look at me. She didn't speak either. She just drove, but she took me in the mall direction. Despite the heavy traffic, like some foreboding sign of crowds-soon-to-appear, I went right on.

"The mall's right over there," I pointed. We had a block to go, and it took us 9 minutes to go one block, or converted to travel time, 1.5 miles an hour. (That's what I do a treadmill).

Anyway, when we arrived at the mall, she couldn't find a parking place. In fact, there were cars parked where parking spaces weren't. The thought of the pharmacist who died and the woman who used pepper spray and the fatigued Target worker in the canal and the assaulters and the shooters all came back to me in one collage. My brain was on overload. I changed my mind but didn't admit it. Besides, I knew she wouldn't get back in time before my time with her was up.

"Maybe later, OK?" I said.

She broke out into a smile, the first of the day.

The Invaluable Hearing Aids, aka Me? Wrong? You Betcha!

In June, 2001, when I started a new job at Jefferson University Hospital in Philadelphia, I was a Technical Trainer and Compliance Administrator, all by myself, for close to 15,000 people. The compliance system we had consisted of reading a set of compliance regulations, like Fire Procedures, Hazardous Materials, and Safety in the Workplace, and answering a series of questions about what they read. 

As soon as July rolled around in '01, a high level meeting took place with the CEO, CIO, President of the Health System, and other muckety-muck types.  I was furtively taking notes because it was my responsibility and I didn't want to miss anything, but I missed half of the discussion and didn't even know it. I felt an arm in my ribs. 

"They're talking to you," a new friend whispered.

I looked up, but I could barely hear the discussion around me. "Yes?" I asked.

The Chairman of the Board repeated the question and I was reading his lips. Then about 10 minutes passed and it happened again. That's when I first learned I was hard of hearing.

A month before when I was hired, it turns out that I was put in a room where, unbeknownst to everybody (at least, no one who admitted it) there were blocked vents, mice droppings and roaches galore. And one of my top allergies, I found out later, was roach dust. I didn't say anything because it was a new job. And I was already a late-blooming 51. I went back to the job and a room that held contagion for me every day until I couldn't. Then I said something and I was moved to little table in another room which I shared with the manager and the training assistant.

I soon had an office when my manager resigned because she couldn't handle me (the final straws were: asking for time off to celebrate the Jewish High Holidays and the manager, aghast at my not knowing you have to ask for time off at least two weeks ahead of time, let me go begrudgingly, and when 9/11 hit, she demanded that I stay in the office, but I said that I had to use the ladies room as a faux excuse in order to call my sons where one who was going to school near D.C. and the other one in Pittsburgh, both places where some of the disaster struck), but that is another story for another day. L. was a disaster as far as managers go. It's a hell of a story.

Anyway, I realized that I needed hearing aids for 11 years. But I waited because I thought they would make me look older, but they don't. They are practically invisible. I can't say enough about my relatively new hearing aids. So apologies all around for the people whom I asked to repeat themselves. When you can't hear, and the words are muffled, it's a fuckin' mess.

No American insurance policy covers hearing aids like they do glasses. Hearing loss is just as important as deficient eyesight, but the insurance masters don't think so. In other parts of the world, industrialized countries supply free or heavily-discounted hearing aids through their publicly-funded health care system.

From a website that dwells on derivations of words, hard of hearing came from the Greek kratos (strength)  from root *kar-/*ker meaning "difficult to do" which is placed c.1200 BC. The term then transferred to the obsolete Middle English meaning "sense of having difficulty in doing something."

I only wish I had a dollar for everybody who asked me (and there were a lot), "Did your hearing aids come about when you had a stroke?" And my answer is always the same: "I got my hearing aids a year and a half after my stroke." Sigh.

A hearing aid is a small electronic device that fits snugly into the ear, consisting of a tiny microphone to pick up the sounds, an amplifier that increases the volume, and a tiny speaker that transmits sounds to the ear, usually with the goal of making speech more intelligible. In the US, hearing aids are considered medical devices and are regulated by the Food and Drug Administration.

But sudden hearing loss for no reason was studied in 2008. The American Heart Association links a relationship between sudden "sensorineural" hearing loss, more easily called SSNHL, and stroke. The SSNHL study, conducted in Taiwan, showed a profound relationship between the onset of sudden hearing loss and stroke. Published in the American Heart Association Stroke Journal, the study implies that sudden loss of hearing might be an precursor to stroke, an actual cerebrovascular event, aka stroke, as much as two years later.

The study, conducted by Dr. Herng-Ching Lin and colleagues at Taipei Medical University, took place over five years and monitored 1,423 patients who had been hospitalized for mysterious and acute sudden hearing loss. Also included as a control group for comparison purposes were 5,692 patients who were admitted for appendectomies. The first group indicating an acute hearing loss was more than 150% more likely to experience a stroke within the two year limit when compared to the control group for appendectomies, leading the researchers to conclude that the number fell "well outside the margin of error." In other words, among patients with sudden hearing loss, 12 percent of strokes occurred within 3 months, 31 percent occurred in the first year, and 51 percent by the end of the second year. That's not coincidental.

Let's take these findings in perspective. In the website "Healthy Hearing,"

• Increasing age (the older you are, the more apt you are to have a stroke, though even young people are susceptible.

• Men are more likely to experience a stroke in their lifetimes than women.

• African-Americans are more likely to experience a stroke than other races and ethnic groups.

• Those with a family history of stroke are at higher risk.

• People with high blood pressure (hypertension) have increased susceptibility.

• Diabetics have more strokes.

• Smoking contributes to the likelihood of a stroke and recently has been tied to hearing loss.

• High levels of cholesterol could mean an impending stroke.

• Obesity is a contributing factor.

So visit your physician or nearest medical center as soon as possible if you have sudden hearing loss. Although there is no standard procedure in treating sudden hearing loss, many physicians will treat with steroids like Prednisone. But you should have more tests for stroke risk. As I say in my book, "The Tales of a Stroke Patient" (the same name as this blog), "If you go to your private doctor, if he or she hasn't thought of it already, demand these tests:

* CBC (This is a routine test to determine the number of red blood cells, white blood cells, and platelets in your blood are A-OK).

* Coagulation tests (PT, PTT, and INR measure how quickly your blood clots. An abnormality could result in excessive bleeding or clotting leading to a stroke).

* Blood chemistry tests (These tests measure the levels of normal chemical substances in your blood).

* Blood lipid tests (This test measures Cholesterol, total lipids, HDL, and LDL, particularly 'bad' cholesterol, or LDL, because it's a risk factor for heart disease and stroke).

Those tests should be enough. If the doctor suspects anything, he or she will send you for additional tests."

Keep this in mind: there's more than a 150% risk of stroke in that patient group that experienced sudden hearing loss when there's no reason. You hear and then you don't. Don't ignore that sign.

You Never Know What Will Bite You in the Ass Next

If I had to recall the most dominant memories of my parents, they are these: My mother who was overly plump always talked about the next meal, and my father who had a short fuse always yelled at me when I couldn't solve a math problem. That was pretty much it. But both my parents shared something in common. They never talked to me about death. So as a result, I thought I could live forever.

My  friend always says, "You were born to die." I always say, "You were born to live." Who's right? Maybe we both are. I used to daydream that I would be the breakthrough person who be subject to cryogenics intentionally, aka frozen in time, and I would wake up to a planet that seemed more like the Jetsons, a cartoon where everything was in the future like Rosie the Robot and flying saucers. But ever since my stroke, I knew that all of us--even me--have to die. It took me 60 years to realize that.

Many people don't know about long-term health care insurance (LTC), an insurance that kicks in once you're chronically disabled. They have exclusions, of course, and each long-term policy differs. In my case, if I had a stroke (which I did), I need skilled assistance with simple activities such as bathing and eating, so I'm covered. Chronic illnesses or other conditions requiring specific needs on a daily basis over an extended period of time are also covered. The thing about insurance is this: Consider yourself lucky if you don't use it. But that doesn't mean you don't need it. Thinking it won't happen to you, especially if you haven't experienced significant health problems in the past, is foolhardy.  

Analysts estimate that by the year 2040, over a million people in the US will exceed 100. Currently, it is estimated that 8 million Americans have LTC.  

You must qualify for LTC. Because health changes as you grow older, it's best to look into LTC before you reach retirement age. Somewhere around a person's late 40s is considered the best time to begin. Premiums among providers of LTC can vary significantly, but each insurer has "sweet spots" in pricing to make the policy more affordable. Most likely, a person is only going to buy an LTC once because it's almost never economically clever to go from one LTC provider to another. As my title says, you never know. Nobody does.

If you're working, employer-based health coverage will not pay for daily, extended care services. Medicare will cover a brief stay in a sub-acute facility or nursing home, or a small amount of in-home care, but it's not without strict conditions. That's where LTC comes in, to help cover long-term (the optimal word is long) care expenses. Some long-term care policies will even assist with the costs in modifying your home so you can be more safe in your familiar surroundings.

But as with everything, there's a wrench. Long-term care insurance options are dwindling. In fact, that's the title of the article written by Emmet Pierce for Insure.com in 2012. It all comes down to economics for insurance providers.

"The market is changing fast because of concerns over profitability," says Mike Skiens, the chairman of the National Long-Term Care Network group. "It’s getting harder to find LTC policies that offer lifetime benefits, leaving policies that offer only several years of protection."

LTC has strong attraction to people who are attempting to protect their estate from losing value. Care covered by LTC policies generally isn’t covered by Medicare, which primarily targets short-term services and rehabilitation, says Pierce.

“Now the carriers are saying there is too much risk associated with them. When you look at the increasing incidents of dementia claims, you can see why [some] carriers are no longer offering those, but they are still offering two-year, three-year, five-year, seven-year plans,” Skiens says.

The baby boomers, who are living longer, bless their ever-lovin' souls,
are the reason for the change. It's not their fault, per se, but the insurers have to worry about their profits. Consequently,  LTC may become prohibitive to the middle class or, in current terms, the 99%. According to the National Long-Term Care Insurance Price Index in 2012, prices for LTC policies today are between 6 and 17 percent higher than comparable coverage only a year ago and have less options.

Allianz, Guardian, MetLife and Unum Group in the last 3 years left the LTC business, according to CBS News. When Genworth Financial, a major provider of LTC, said it was reducing LTC operations, that announcement sent shivers through the industry. None of the companies, by the way, that left the LTC market, will stop honoring the LTC policies they already have sold. (Whew!)

In the early years, insurers were less concerned with potential losses. “There was a tremendous amount of unlimited benefits being purchased,” says one analyst. “I call that the open checkbook.”

The longer you live, the more likely you are to use your LTC policy, but not everyone should buy one, says AARP. If you have to use money that otherwise would be spent on such necessities as food, shelter, and clothing, the necessities come first.

So how much is LTC? The average annual premium for a policy with four or five years of coverage sold in 2010 to someone age 55 to 64 is $2,261. While the policies are not cheap, not having LTC coverage can be even more expensive. The average annual private pay cost of nursing home care this year is about $88,000 and exceeds $100,000 in 10 states, according to AARP’s Long-Term Care Insurance 2012 update. 

The base price for assisted living facilities averages $41,000 annually. Adult day services, which allow people to remain in their homes, average $66 per day. Companies that provide licensed home health aides not certified by Medicare charge an average of $20 hourly, according to the AARP report. Many insurers now will continue offering LTC policies, but they won’t be as comprehensive.

On the theory that something is better than nothing, I bought the cheapest LTC policy. That policy was all I could afford. I'm glad that I have LTC, purchased in time, when a short time later, the whole world, as I knew it, would come crashing down.

Sleep and Stroke: WTF? You're Asleep Already?

"Are you asleep?"

I whisper the words, but loud enough for him to hear it. I don't get a response--not a foot twitch, not a hand movement, not a face gesture. I get nothing. He lies down and then, somehow, he is instantly asleep. Lucky him. But to this stroke survivor, not so fast. I often get up, in the middle of the night, because I can't fall asleep and don't want to lie there endlessly for more than two hours which is my limit, waiting for sleep to overtake me. 

It's unfortunate for me that I'm so active in the middle of the night. I get up and do something else, like go downstairs to my office to write, or flip through my kids' pictures--again, or listen to the night sounds of the ocean crashing against the surf. Oh, boy. I have to get up early. The vampire, aka phlebotomist, is coming at 8. *sigh* The time is now 1 AM.

First, background is needed. The National Institutes of Health say that until the 1950s, most people thought of sleep as a short, daily hibernation from our hectic lives. What we know now, over fifty years  years later, is that our brains are busy during sleep, affecting our physical and mental functioning in a slew of ways. Sleep comes in stages: 

Stage 1 is denoted by  light sleep where we drift in and out of sleep and can be awakened easily;
 
Stage 2 sleep is characterized by eye movements stopping and brain waves become slower;
 
Stage 3 happens when slow brain waves begin to appear, combined with smaller, faster waves;
 
Stage 4 is the deepest sleep when there is no eye movement or muscle activity;
Rapid Eye Movement (REM) sleep, occurring about 70 to 90 minutes after we fall asleep, is when our breathing becomes irregular and shallow, eyes move quickly, limb muscles become temporarily paralyzed, heart rate increases, and blood pressure rises.

On average, the Cleveland Clinic says a complete sleep cycle takes an average of 90 to 110 minutes.
 
As the night goes on, REM sleep increases in length while deep sleep decreases. The amount of sleep each person needs depends on age and condition. Infants usually require about 16 hours a day, teenagers about 9 hours, adults usually about 7 to 8 hours though some people need as few as 5 hours or as many as 10 hours of sleep. In the first 3 months of pregnancy, women often need several more hours of sleep than is their typical pattern. If you're sleep-deprived, the body requires you  to make it up later when you have the opportunity. You can't go without sleep for two days because sleep will catch up with you. It's a fact. Don't even argue it. You'll lose.

And most sleep studies conclude that sleep deprivation is dangerous. Sleep-deprived folks when tested perform as badly or worse than those who are intoxicated. Sleep deprivation also intensifies alcohol's effects on the body. Since drowsiness is the brain's final step before falling asleep, driving while drowsy--intoxicated or not--can lead to tragedy. Coffee, tea, or other stimulants doesn't cut it with severe sleep deprivation. The National Sleep Foundation has a rule: if you can't stop yawning and have trouble keeping your eyes focused, or if you can't remember driving over the space of three minutes, you are probably too fatigued to drive safely.

Anyway, it's the same thing one or two times every week that I can't sleep, but I'm certainly not alone. Sleep problems are usual for stroke survivors. Having a sleeping problem can be make you irritable and cantankerous, like saying "fuck" when uttering that word is uncalled for. 

Sleep problems can also increase your risk for another stroke because two-thirds of stroke survivors have sleep-disordered breathing (SDB), the most common being sleep apnea. With SDB, the side effects may increase your blood pressure and cause blood clots. Signs include, despite yawning repeatedly, the inability to fall asleep or remain asleep throughout the night which, in turn, causes excessive sleepiness, attention problems, depression, irritability, and headaches during the day. SDB is a vicious cycle of events.

Treatments are tricky. Aside from sleeping on your stomach (some people say that helps with the snoring), the most successful treatment is Continuous Positive Airway Pressure (CPAP), which is a compact machine no larger than a few reams of paper, blowing heated, humidified air through a short tube to a mask which fits tightly around your nose and mouth to prevent humid air from leaking out. Albeit not good for curly air that might to turn to frizzy hair, it might help. The National Stroke Association said sleep studies using CPAP revealed that better thinking abilities and having higher energy levels were the result.

A variety of medications prescribed in the rehabilitation process can change the quantity, quality, and pattern of sleep. Medications prescribed for sleep may interact with sleep processes by increasing or decreasing the amount of time spent in sleep. The intake of medication and its timing can also influence sleep quality in a negative way and should be monitored carefully. 

Inherent factors to the hospital or rehabilitation environment may, in themselves, contribute to produce sleep disturbances in some patients, like co-habitation with other patients, pain, anxiety, noise, lights, and the strict schedules for a routinized day. Then when the stay comes to an end, patients must integrate their lifestyle to accommodate the home environments. Any factor alone isn't a walk in the park, by no means. 

When the patient returns home, resuming sleep patterns may not happen if these conditions are present:
* Consuming big meals late at night
* Ingesting alcohol, caffeine, and nicotine in irregular patterns
* Performing extreme exercise  
* Maintaining obesity which is linked to sleep disordered breathing
* Taking naps within three hours of bedtime
* Incurring emotional upheaval 

An average of 30% of stroke survivors have “circadian disturbances” or sleep-wake cycle disorders (SWDs) where your sleep regimen is no longer set by day or night. But in my mind, no matter what acronym one calls it, many stroke survivors are left with, in conjunction with other sleep disorders, the big "i"--insomnia, the inability to fall asleep. An insomniac is usually defined by the following criteria: 
* Dissatisfaction with sleep quantity or quality
* Difficulty initiating and/or maintaining sleep
* Recurring sleep difficulties at least 3 nights a week
*Significant impairment in social, inter-personal, or other areas of daytime interactions

Insomnia is considered chronic when it has lasted for more than 6 months. Mine had lasted for 4-1/2 years.

Sleep is still in the partial mystery category. While researchers and doctors know something about sleep, like the regulation of the body's temperature, the conservation of energy, and immunity to disease, they don't know everything. 

When it comes to rehabilitation, pioneers in sleep disorders, Canadian researchers Marie-Christine Ouellet and Simon Beaulieu-Bonneau, said even though problems with sleep are often regarded as minor problems, the lack of sleep is developing into a serious problem. It can retard rehabilitation and make a difference for patients in their outcomes. With the efforts involved in rehabilitation, it is important to deem sleep disorders as possible roadblocks to the entire rehabilitation process. 

Indeed, it was a roadblock for me. I don't think I was in a state of mind to receive therapy as soon as I did. So should there be time allowed before the stroke patient is ready for therapy, or should therapy start right away even though the patient's not ready to receive it? I don't know the answer. Nobody does. And hospitals don't have the money for psychologists to pave the way for therapy.

It's 2:30 AM now as I write this post. Sleep is the furthest thing from my mind.

How to Change Your Own Mind, Literally

"You can't be too skinny or too rich," said my old college buddy back in the 60s. But now you know the truth. Skinniness sometimes is related to anorexia or bulimia. And you've heard stories about the deaths of lottery winners who blew their money on drugs or died from being poisoned. My friend got it wrong. She should have said, "You can't be too brainy."
 

The brain controls everything, like our emotional outbursts to pain, our nervous eating, our ability to pee regularly, our resistance to confront people, our neurotic tastes. But what was thought prior to the 1970s--that the brain was fixed and couldn't be changed after early childhood--was wrong. The brain can process new experiences, like having a stroke, by creating neural pathways to accommodate them. Welcome to neuroplasticity, the game changer.

There are four key truths about neuroplasticity:

Neuroplasticity is ongoing throughout life and involves brain cells and neurons.
 
Neuroplasticity can happen for two distinct reasons--as a result of learning, experience, and memory or as a result of brain damage.
 
Neuroplasticity can vary by age, and while plasticity occurs throughout life, certain types of changes are more predominant.
 
Neuroplasticity and environment, both together, play an essential role in the process.

In the first few years of life, the brain is growing rapidly. The average adult brain grows slower because as we process new experiences, some connections are strengthened while others are merely replaced by the process known as synaptic pruning. By developing new connections and pruning less important ones, or synapses we don't need at all, the brain is able to change either size or shape, and maybe both.

The human brain is made up of around 100 billion neurons. Early research was comfortable in the fact that neurogenesis, or the creation of brand-new neurons, was over after birth. Before the 1970s, most researchers believed that the brain and nerves could not regenerate themselves to replace damaged ones. Most stroke patients and individuals with brain trauma were convinced that brain damage from accidents or disease was there to stay. Areas of the brain that were dedicated to control the movement of arms and legs, for example, were expected to stay just that way from trauma following brain injury. The brain was not capable of relearning lost functions, most researchers said, because the brain was deplete of plasticity.

In the 1970s, in experiments with rats, researchers found a region of the

animals' brain--the hippocampus--where new nerve cells were miraculously generated. The hippocampus region is where memories of new things and places are established, and the scientists found two cavities in the hippocampus where the new cells were generated. These cells, called stem cells, traveled to different parts of the brain and took on the functions of that specific area of the brain.

So neurologists a few years later were excited and actively worked with

human patients who had brain injuries, and they were enacting experiments in animal models to determine whether the brain could be re-mapped following injury. Neurologists along with researchers knew what part of the brain controlled the activity of various body parts. A major part of this effort was determining what types of physical therapies were suitable in retraining those parts. Neuroplasticity was indeed coming to the forefront and was seen in animal experiments where a number of physiological changes were observed--changes in the size and shape of brain regions, increases in the molecules that assist and  transmit signals through the brain, and the generation of new neurons.

Michael Merzenich is a neuroscientist who is known for being a frontrunner in the field of neuroplasticity. For over thirty years, he has made some remarkable finds. For example, in a post-doctoral experiment in the 70s, he cut the peripheral nerve of monkeys' brains and sewed the ends together again. The result was that those brains was nearly normal, prompting Merzenich to conclude, "If the brain map could normalize its structure in response to abnormal input, the prevailing view that we are born with a hardwired system had to be wrong. The brain had to be plastic."

Today, it is documented that the brain possesses the capacity to redo neural pathways, regenerate new connections and, in some instances, create new neurons. NICHD-funded researchers have concluded that the brain is receptive to neuroplasticity. The magnetic resonance imaging (MRI) can also tell where the  neuroplastic events occur. In a recent stroke patients' study, the MRI detected where neurons sprung new connections that extend into the area surrounding the affected site.

So the question is, if disabled or not, what can YOU do about enacting neuroplasticity on your own brain, i.e. be more brainy?

1. Plenty of studies have linked meditation and yoga to changes in the density of gray matter or cortical thickness. In 2000, Sara Lazar from Harvard , and Richard Davidson, a neuroscientist at the University of Wisconsin, teamed up with the Dalai Lama on what results would be incurred on the brain. The results suggested changes in different levels of activity associated with such qualities as anxiety, depression, attention, fear, anger, and the capability of the body to heal itself. (Yes, there are modified meditation exercises for the disabled. Call around).

2. In another study, mice who were coerced to run on treadmills showed signs of molecular changes in many portions of their brains when viewed under a microscope, while mice who had the comfortable wheel-runner had changes in only one area. Chauying J. Jen, a professor of physiology and an author of the study, said, "Our results support the notion that different forms of exercise induce neuroplasticity changes in different brain regions." (So when it comes to humans at the gym, sometimes pain IS gain).

3. Hyperbaric oxygen therapy, or HBOT, is an simple treatment with catastrophic results. Patients inhale oxygen while inside a mildly pressurized chamber. The oxygen dissolves  into the blood, plasma,  and tissues. HBOT enables oxygen to go into areas with restricted blood-flow caused by injury or disease, thus stimulating the body’s natural healing process. Oxygen is a basic part of our physiology. Among other things, we require oxygen to heal from injuries and illness. During a normal day, the average adult inhales approximately six pounds of oxygen, of which about 2 pounds are automatically dissolved into the blood. While inside the chamber, patients inhale oxygen in its purest form at ten times the normal rate. (Some people said it's phenomemenal, even for stroke survivors. Start with the Washington Hyperbaric Therapy Center, (425) 644-7999, to learn more). 

4. Lumosity.com says it targets core cognitive processes that underlie performance in many different areas, and these processes include attention, flexibilty, memory, and focus. You can subscribe to Lumosity and play 5 games at a time to build up your endurance or, if money's an issue, you can play some games for free. It has a Brain Profile Index where you can compare scores over a period of time. (Lumosity, which was a gift from my son, is a staple for me now).

But sometimes, nothing helps but patience and hope. I've got both of them... literally.

ALERT: Why You Didn't Read My Last Post About The Handicapped: You're Scared to Tempt Fate

This post is a short one and I'm going to be shouting at you. I wrote my most recent post, "The Handicapped in America: The ADA Has Your Back" (http://stroketales.blogspot.com/2013_08_12_archive.html) in my blog "The Tales of a Stroke Patient," about the Americans with Disability Act (ADA). I also have a dashboard, as the administrator of the site, that tells me how many hits I got. I haven't had such low numbers ever. (I put "ALERT" in the title to get your attention. Did I succeed? Maybe).

Of course, there's a reason for almost everything unless you're spiritual, and then I have to correct myself and say, there's a reason for everything. And there's a reason for why many of you didn't read the  post.You're afraid to read anything handicapped-related because you don't want to tempt fate. 

A lot of people believe in fate. There's a good chance you're one of them. Fate is defined in Webster's as "the will or principle or determining cause by which things in general are believed to come to be as they are or events to happen as they do." To tempt fate is to push the odds in fate's favor, to make fate go the wrong way--or the right way--depending on what's at stake. Handicapped anything is bad news.

"The Antidote," which I read twice, is a book whose mission is to poke holes in positive thinking. Anybody who's handicapped and thinks that's a good thing lives in a delusional world if they truly believe it or have the ability to move forward. I don't have either. I worked for an international law firm and the job was taken away from me because I had a stroke. HOW IS THAT A GOOD THING?

Anyway, please read my post "The Handicapped in America: The ADA Has Your Back." I said in my book, with low cholesterol, low blood pressure, no diabetes or obesity, following a healthy diet, if I could have a stroke, ANYBODY could have a stroke. Did I upset you? Good. Maybe now you'll pay attention to handicapped anything, like strokes, the largest long-term disability group. Get tested for your clotting levels. You don't want to have a stroke. Or another one!

Right now, I'm wearing high socks in the heat of summer to protect my skin from the perpetual brace, I'll eat no chocolate after Coumadin, a blood thinner, because that could affect my clotting levels, I'll drink no alcohol when everybody else is imbibing, yada, yada, yada.  

Maybe now....

The Handicapped in America: The ADA Has Your Back

My mother-in-law used to always have a lawsuit going on. But, alas, they were frivolous suits, mostly slips and falls in the market, on someone else's sidewalk, or falls in the street, all when barriers were in her way, where she just bruised herself almost every time. And she wasn't handicapped. She was clumsy. In all that time, around 30 years, I thought about when would be the next time for her, and I didn't give one thought, not a single one, to handicapped people who really had to be worried about barriers.

I am now handicapped from the stroke, but the government protects you--sort of. The Americans with Disabilities Act (ADA) was signed into law July 26, 1990 by George H. W. Bush, so don't say Bush was a bad president. Oh. My bad. That was his son.
 

Anyway, the ADA was later amended with changes on January 1, 2009. The ADA is really a civil rights law that prohibits, in most cases, discrimination based on disability. Disability, as defined by the ADA, is "a physical or mental impairment that substantially limits a major life activity." Excluded are those with vision impairment, fixable by lenses, and drug users because those conditions can be repaired. (Are you listening, drug users? There's hope for you yet, but not through the ADA).

Look at some of the lawsuits filed recently in the past and the winners from them:

Barden v. The City of Sacramento
The City of Sacramento failed to bring its sidewalks into compliance with the ADA. Certain factors were resolved in Federal Court. One issue, whether sidewalks were covered by the ADA, was appealed to the 9th Circuit Court of Appeals  of Appeals, which ruled that sidewalks were a "program" under ADA and must be made accessible to persons with disabilities. The ruling was later appealed to the U.S. Supreme Court, which refused to hear the case, letting stand the ruling of the 9th Circuit Court.
Winner: Barden

Class action suit v. Expedia.com and Hotel.com 
Customers with disabilities could not book hotel rooms, through their websites, without substantial  efforts that persons without disabilities were not required to perform.
Winner: Class action
 
Bates on behalf of Deaf/Hard of Hearing v. UPS
UPS failed to address communication barriers and to guarantee equal conditions and opportunities for deaf employees; Deaf employees were mostly excluded from workplace information, denied opportunities for promotion, and in harm's way due to 
unsafe conditions due to lack of accommodations by UPS
Winner: Bates on behalf of Deaf/Hard of Hearing
 
National Federation of the Blind v. Target Corporation
Target Corp. was sued because their web designers failed to design its website to enable persons with low or no vision to use it.
Winner: National Federation of the Blind
 
Michigan Paralyzed Veterans of America v. The University of Michigan 
Michigan Stadium violated the Americans with Disabilities Act in its $226-million renovation by failing to add enough seats for disabled fans or accommodate the needs for disabled restrooms, concessions and parking. In addition, the distribution of the accessible seating was at issue, with nearly all the seats being provided in the end-zone areas. The settlement required the stadium to add 329 wheelchair seats throughout the stadium by 2010, and an additional 135 accessible seats in clubhouses to go along with the existing 88 wheelchair seats.
Winner: Michigan Paralyzed Veterans of America
 
Spector v. Norwegian Cruise Line Ltd. 
The defendant argued that as a vessel flying the flag of a foreign nation was exempt from the requirements of the ADA. This argument was accepted by a federal court in Florida and, subsequently, the Fifth Circuit Court of Appeals. However, the U.S. Supreme Cout reversed the ruling of the lower courts on the basis that Norwegian Cruise Lines was a business headquartered in the United States whose clients were predominantly Americans and, more importantly, operated out of port facilities throughout the United States.
Winner: Spector
 
Access Now v. Southwest Airlines 
The District Court decided that the website of Southwest Airlines was not in violation of the Americans with Disability Act because the ADA is concerned with items with a physical existence and thus cannot be applied to cyberspace. But Judge Patricia A. Seitz found that the "virtual ticket counter" of the website was a virtual construct, and hence not a "public place of accommodation."
Winner: Access Now


Don't think the court is up to its neck with ADA lawsuits. The ADA had yielded a unusually miniscule number of lawsuits on employment issues--only about 1,200 across America in the first seven years of the statute. But as with all statutes, once people know them and what they include, many disabled people file worthless actions, thus, every ruling does not benefit the handicapped. For example, an qualified job applicant or employee with a disability can claim employment discrimination under the ADA, but job applicants must meet all the necessary requirements of the job with or without reasonable accommodation. Small businesses with fewer than 15 employees are not covered by the ADA.

The ADA covers individuals with psychiatric and neurological impairments that mostly limit essential life activities because individuals with such impairments have traditionally been subjected to ongoing employment discrimination, not because they are unable to successfully perform job duties, but because of fears and stereotypes associated with such impairments. Psychiatric impairments involve social, biological,or psychological dysfunction. Neurological impairments are conditions or diseases involving the nervous system, like the brain, spinal cord, and nerve centers.

The ADA, at the heart of it, is all common sense. For example, with the ADA excluding people with interim physical problems, it also excludes people with short-term mental health problems, too. The law recognizes that modifying existing structures is more expensive than making new construction accessible. The law only requires that public accommodations, like restaurants, stores, banks, and hotels, remove barriers in existing facilities when it is readily achievable. 

Inexpensive, easy steps that can be taken to help the disabled include, for instance, a ramp to cover five steps, a bathroom grab bar to help with balance, special hinges to widen a doorway, a paper towel dispenser that's low enough to reach, and an accessible parking space.

The ADA requires all government programs to be accessible, not all government buildings. The ADA only insists that clear communication not exclude people with disabilities, like providing them with written materials instead of watching a PowerPoint that they can't easily see or hear. But the law does not require any measure that would cause extreme financial or administrative difficulty to the employers. Remember in the beginning when I said "sort of"? That judgement, right there, is arbitrary. In other words, how much difficulty is too much?

While people have the right to file lawsuits, not all suits are winners for the handicapped. On its website, http://www.eeoc.gov, the U.S. Equal Employment Opportunity Commission (EEOC) is responsible for 

"enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability or genetic information. It is also illegal to discriminate against a person because the person complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit." But Human Resources departments everywhere don't abide by that ruling. If they want to get you for filing a discrimination suit, they'll figure out a way.

The EEOC has authority to dismiss the complaint. Trivial complaints do not make it through the system. EEOC investigators are taught to scrutinize whether one person or a party, like class action suits, has an actual ADA disability. Go to https://egov.eeoc.gov/eas/ if you think a charge should be filed.

So there you have it, everything I know about the ADA. Hmmm. It's too late to file a complaint against my former manager, J, and her boss, stupid D, for making cracks about my lack of hearing when I asked them to repeat themselves. Actually, it was D's fault. My hearing went south because the work environment in which I was located initially, with observable roaches and vermin, affected my ability to hear clearly.

"You don't hear anyway," was doltish J's remark.  D used to roll his eyes and twitch his jaw if the remark had to be uttered again.

I didn't know about the EEOC back then, but I surely wish I had.

"The Tales of a Stroke Patient"....YES!

“The Tales of a Stroke Patient” is making its way into the limelight.

I am a stroke survivor, and I’ve written a book that tells of my expedition. If a stroke could happen to  me, with low cholesterol, low blood pressure, no diabetes or obesity, it could happen to ANYBODY!

If you’re a stroke survivor, caregiver, have stroke in your genes, an avid reader of memoirs, or just curious if a stroke could happen to you, please read my book that will educate and inspire to make stroke awareness so much bigger than it currently is. 

Warning: Not intended for the faint of heart or politically correct crowd.

Click the link to buy it:

from the publisher, http://bookstore.xlibris.com/Products/SKU-0115053049/The-Tales-of-a-Stroke-Patient.aspx,

or for Amazon’s Kindle, http://www.amazon.com/The-Tales-Stroke-Patient-ebook/dp/B009J9QC64/ref=sr_1_1?ie=UTF8&qid=1373898600&sr=8-1&keywords=tales+stroke+patient

or for Barnes & Noble’s Nook, http://www.barnesandnoble.com/w/the-tales-of-a-stroke-patient-joyce-hoffman/1113052852?ean=9781479712496.

Don’t have a credit card? Message me by email--hcwriter@gmail.com--or Facebook to see how you can get a copy!