How Did "Stroke" Become Its Name?

This post is a change from the usual, which I needed, having researched and wrote about urination and constipation in my last two posts. Give this girl a break! They were important to write about and nobody else seemed to be doing it, but c'mon. Thus, a change from the usual.

So I was always fascinated with the derivation of words. I probably should have taken Latin in high school, but I didn't, being too occupied by the male gender and taking as little effort as possible with my studies. That's why I went to Temple University. Everybody gets in to Temple. 

Anyway, because of my love for the written word, and finding writing easy, I had a column in the local paper, Teen Scene, at the tender age of 16. I got paid $10 a column in the mid-60s which was a lot of money for me back then. I went on to many other opportunities including columns at other local papers when I was in my twenties and a freelance gig with a consumer column in the The Philadelphia Daily News and articles in The Inquirer when I was in my thirties. I tell you all this because writing came effortless to me, and it was the one thing which made me proud to be a writer. I went on to many other jobs, but they all involved writing. Thus, my magnetism to the written word was notable. 

So I always wondered about the word "stroke" and its derivation after a few years of depression when I had a stroke. I wondered but didn't do anything about it until now. So here is what I found, compliments of Johns Hopkins Health Library. 

In ancient Greece over 2400 years ago, Hippocrates, the father of medicine, first knew of "stroke" who referred to it as apoplexia, a term meaning "struck down by violence."  In the mid-1600s, Jacob Wepfer discovered that patients who died with apoplexia also had bleeding in the brain and realized that a blockage in one of the brain's blood vessels could cause apoplexia. Apoplexy, as the term was used more in centuries that ensued, meant that a person suddenly developed paralysis and a variety of changes in appearance and mood. At that time, doctors had no or little knowledge of paralysis and the brain.  

The science of medicine at times continued to study the cause, symptoms, and treatment of apoplexy when in 1928, apoplexy was divided into categories, based on the source of the problems with the blood vessel. This progression evolved to the term "cerebral vascular accident" (CVA). CVAs were referred to as a "brain attack" to note a lack of blood supply to the brain, similar to a heart attack which is caused by a lack of blood supply to the heart. Brain attack also suggested an immediate emergency procedure.

The original Greek terminology, "struck down by violence," (it  could have been called "struck") eventually turned into "stroke" (or apoplexy, which means the same thing as stroke), and apoplexy became "old school" in the 20th century. Doctors still say CVA, but stroke became the usual term with the general public. 

Doctors most often recommend to stop smoking, a healthy diet low in sodium and plenty fruits and vegetables (fruits are higher in carbohydrates than vegetables, so think about that if you're watching your carb intake), and exercise at least 3 to 4 days a week for at least 40 minutes a day. For stroke survivors who have trouble doing the 40 minutes all at once, most PTs (physical therapists) say break the 40 into smaller intervals until your endurance can handle 40 minutes at one time.

While a stroke can’t always be prevented--I got my stroke from lousy genes, Protein S Deficiency, which messes with coagulation and clots--taking these guidelines can only help reduce your stroke risk as much as possible besides leading you to a more healthy lifestyle. In addition, it may help you avoid another stroke if you've already had one. 

Stroke Survivors: How Allergies and Stroke Are Related

It seemed a good time to reveal the connection between allergies, or sinusitis, and stroke with allergy season right around the corner. 

A long, long time ago, when I was 12, I went to the circus with my parents and to their friends' house after. I developed allergies then, to all the animals, never having a pet of my own at home. My mother wouldn't allow any pet to wander about except those that were boxed, caged, or swam under water. Thus, I never was subject to knowing.

When we stopped at the friends' house after the circus, I was already wheezing, congested, hive-y, and miserable. My mother told me to be friendly and stop whatever I was doing. But I didn't stop because I couldn't. Finally, after 2 hours, we arrived home and I took the next day off from school because I was so fatigued. Welcome to anaphylaxis.  

First, a little background. Anaphylaxis, aka a severe allergic reaction, is known and diagnosed by respiratory and circulatory dysfunction, and usually associated with skin (for example, hives) and mucous changes. Anaphylaxis may be deadly when the circulatory and respiratory systems are severely disrupted. When death occurs, it is usually the result of anaphylactic shock. I was lucky. The symptoms went away by themselves by the next afternoon. 

I'm allergic to aspirin and NSAIDS (non-steroidal anti-inflammatory drugs), too. About 20 years after the wheezing et al episode, I took a Motrin, an NSAID, for a bad back and the exact thing happened. This time, I went to the doctor that same day and he told me that I had an anaphylactic reaction.  

Sinus problems, or acute sinusitis, related to anaphylaxis affect 1 in 5 American adults each year, according to the Asthma and Allergy Foundation of America. Sinus conditions can trigger headaches and congestion (and there's much more), but a new study from Taipei Medical University in Taiwan says "the inflammation that causes the pain and pressure of a sinus infection also increases the odds of suffering a stroke— by 34 percent for people with chronic sinusitis and by 39 percent for those with occasional acute infections." The relationship of acute sinusitis to stroke reflects more of a risk to adults in midlife, since about 37 percent of stroke patients are between 45 and 65, according to the Centers for Disease Control and Prevention. "Sinus infections are most commonly caused by the same viruses associated with the common cold," says Dr. Meera Gupta, assistant professor of allergy and immunology at University of Texas Medical Branch at Galveston.  "When a virus sets up shop in your sinuses, it produces inflammation that causes the telltale pressure around the nose and eyes. In addition to a headache, the infection can sometimes bring on congestion that lasts about a week, along with thick, discolored mucus and facial or tooth pain. Typically, these infections will resolve on their own within 7 to 10 days," Gupta says.  In roughly 2 percent of cases, the infection doesn't resolve, an indication that a bacterial infection requiring antibiotics may happen.  The constant need to blow your nose and the pain can be bothersome. The inflammation in your sinus cavities can also trigger a stroke. Sinus inflammation, located close to your brain [the operative phrase], may also put pressure on the  arteries which could prevent normal blood flow and lead to a stroke. So the relationship between anaphylaxis and sinuses is this: The first step in preventing anaphylaxis is avoiding the allergen(s) that can cause you to react.   For typical inflammation, over-the-counter nasal sprays should suffice," says Dr. James Stankiewicz, chairman of the Department of Otolaryngology at Loyola University Medical Center in Illinois.  "Sprays made from saline or saltwater are sold over the counter and help drainage. Decongestant sprays, which may be prescription or over the counter, help open the nose to breathe and reduce congestion and drainage." Steroid sprays and nasal saline irrigation, usually with salt water, are good as well, Stankiewicz says. "Seasonal allergies are another major cause of sinus inflammation. Allergies can block normal sinus drainage and predispose a person to developing sinus infections," Stankiewicz says. If you experience congestion or sinus irritation during hay fever season, when the pollen count is high, or if you are exposed to animal dander or mold, there's always allergy shots that usually take a minimum of 9 months to determine protection from allergens. Sinuses can also be a path to leave you vulnerable to compromised health beyond the proven stroke risk.  "Chronic sinus congestion can lead to snoring and sleep apnea, which is associated with an increased risk of cardiovascular disease," Stankiewicz says. "In addition, chronic inflammation in the sinuses associated with allergies can cause lethargy, fatigue, and cognitive impairment." Most anaphylactic reactions occur after eating or drinking a particular food, taking certain medication, after an insect sting, or after exposure to an allergen like latex gloves.  In rare cases, anaphylaxis can happen after exposure to the cold or after exercising, as it did to me after running in the cold with wheezing and hives in the aftermath. Sometimes, you'll find out the hard way, never knowing before that you were allergic. Life's a bitch, but it beats the alternative.

Constipation for Stroke and Other TBIs: Well, SOMEBODY Had to Write About It and It Might As Well Be Me

I had constipation after the stroke. It wasn't unusual for me to defecate once every 5 or 6 days. A few doctors told me that the muscles in the bowel weren't working correctly. That was the easy answer. And I believed it because nothing was working correctly. I believed it until I did research on constipation. And the doctors may have been wrong. 

According to researchers at the University of Michigan, "Stroke by itself does not cause constipation. But constipation often occurs after a stroke because you 1) are not drinking enough liquids, 2) are in bed most of the time, or 3) are taking certain medicines as part of your treatment. If your constipation is severe, stool can become lodged (impacted) in the bowel."

That was me, all right. All of it. 

In another article in the Annals of Rehabilitation Medicine, the researchers took 55 brain-injured patients. They divided the patients into constipation (number=29) and non-constipation (number=26) groups, achieving 7.32± (plus or minus) 3.63 and 5.04± (plus or minus) 2.46, respectively. 

The constipation group had significantly elevated constipation scores, with prolonged CTT (Colon Transit Time, the colon responsible for producing the bowel) of total right and left colon, and it depended on these factors in a table entitled, "The General Characteristics of Patients with Brain Injury:" 

Total Number of subjects                                   55

Mean age in years                                               61 +- 14.1

Sex (male/female)                                               37/18

Brain injury in months                                       11.1 +- 17.5

Type of brain injury (infarction, bleed, other)  33/20/2
(Press your doctor for where in the brain your injury occurred)
Site of brain injury 
Frontal/Parietal          5
Temporal/Occipital    7
Basal ganglia           24
Thalamus                   6
Multiple                      3
Other                        10

But the article didn't say how much liquid they drank, how much bed rest, or what kind of medicines they took. In my opinion, University of Michigan hit the mark: ie, too little liquids, too much bed rest, and/or medications.

My solution to constipation was when a doctor recommended a stool softener. I was afraid at first because I thought it would give too strong an urge to make it to the bathroom. 

After 5 years of constipation, the stool softener improved my quality of life because I "go" once a day or so without any urgency. And I eat everything that's supposed to be in a healthy diet with no restrictions (except keep a consistent diet of Vitamin K because I'm on Coumadin). See a doctor first because something else may be afoot, but if the doctor says to try stool softeners for constipation, permit the bowel to go forth. I buy the cheap kind from Walmart. 

I'll end with this cartoon that says it all, to both pee (https://stroketales.blogspot.com/2019/03/incontinence-for-stroke-and-other-tbis.html) and poop:

Incontinence for Stroke and Other TBIs: Well, SOMEBODY Had to Write About It and It Might As Well Be Me

Once upon a time, before I had the stroke, I used to sit for long, agonizing hours at my office desk, and didn't urinate for 12 hours while drinking boatloads of coffee and water. I didn't want to leave my desk for fear the boss wanted something earth-shattering, silly office things, like telling us who passed gas in front of the Director or who got canned because he watched Westerns on his office computer. He always wanted us available for things. Things that could wait. 

As a result, I got used to not peeing. I developed a remarkably humongous bladder (5 doctors at 5 offices in 3 different states said so after I had CT scans) and I had, I might add, constant UTIs (urinary tract infections). You're supposed to "pee" after drinking massive amounts of fluid.

Anyway, despite my inordinately large bladder, I developed incontinence after I had my stroke. I was constantly leaking. So I took to Poise to help with the embarrassment, larger and thicker pads until I was at #6, the Ultimate. Ultimate absorbency, the ominous sign above a grocery shelf said. Ultimate absorbency. I had reached the limit. 

Why was this happening? Soon, in about a week's time of research, I had my answers. And we're off!

No matter how you explain it, everything comes from the brain. And The American Urological Association (AUA) has a simple answer. 

It's called a neurogenic bladder, or bladder dysfunction. 

"The bladder and kidneys are part of the urinary system," the AUA says. "These are the organs that make, store, and pass urine. When the urinary system is working well, the kidneys make urine and move it into the bladder. The bladder is a balloon-shaped organ that serves as a storage unit for urine. It is held in place by pelvic muscles in the lower part of your belly."

The AUA goes on to say that the nerve signals in your brain let you realize that your bladder has to empty itself. Then the  brain tells the bladder muscles to contract, allowing urine out through your urethra, the tube that carries urine out of your body. Your urethra muscles are called sphincters that keeps the urethra shut until you're ready to "pee." 

If these nerves are damaged by illness or injury, the muscles may not be able to relax or tighten at the correct time. As a result, bladder muscles may be overactive and squeeze more often than normal before the bladder is full, or sometimes the muscles are too relaxed and let urine come out before you're ready, or sometimes the sphincter muscles around the urethra remain tight when you are trying to empty, and sometimes people have both overactive and underactive bladder at different times. Don't bother with the distinctions. If you're leaking or gushing, you're wet to some degree. 

Maybe you're a visual learner, so how about this? Remember. Start at the top with the brain.

If you have neurogenic bladder, or incontinence, see your doctor. It can't be cured, but it can be managed. 

I came across 2 interesting therapies, the one involving surgery, the other a needle:

Sacral Neuromodulation: When drugs or lifestyle changes don't help, there's sacral neuromodulation. The sacral nerves carry signals between your spinal cord and the bladder, allowing the surgeon to place a narrow wire in proximity to the sacral nerves. A wire is connected to a small, battery- operated device that is placed under your skin. The harmless electrical impulses to the bladder stop the signals that can cause the bladder to leak.

Percutaneous Tibial Nerve Stimulation: This type of  neuromodulation involves a needle that's inserted into a tibial nerve in your leg, most likely the ankle. The needle, connected to a device that emits electrical impulses, travel to the tibial nerve, and then to the sacral nerve. This procedure is done in your doctor'ss office, and patients ordinarily receive 12 treatments for top results. 

The AUA says that certain drinks, foods, and medications may act as diuretics, stimulating your bladder to "go" more often. They include:

• Alcohol
• Caffeine
• Chocolate
• Carbonated drinks and sparkling water
• Heart and blood pressure medications, sedatives, and muscle relaxants
• Large doses of vitamin C

Persistent urinary incontinence may be caused by underlying changes, including:

• Neurological disorders, like stroke or other TBIs 
• Pregnancy
• Childbirth
• Age changes
• Menopause
• Hysterectomy
• Enlarged prostate
• Prostate cancer
• Obstruction, such as a tumor or urinary stones
• Hysterical laughing or annoying coughing

Risk factors that increase your risk of developing urinary incontinence include: 

• Gender
• Age that weakens the muscles involved with urination
• Being overweight
• Brain injury
• Smoking
• Family history (lousy genes will get you every time)
• Other neurological diseases 
• Diabetes

As I said before, urinary incontinence may not be preventable, but you have to maintain a healthy lifestyle, including: 

• Maintain a gender-specific correct weight
• Practice pelvic floor exercises 
• Avoid bladder bothers listed above 
• Don't smoke, the perennial favorite
• Avoid constipation by eating more fiber, constipation being one of the causes of urinary incontinence

Easier said than done? Maybe. But as the quote-worthy Mark Twain once said, "The only way to keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not." 

I think Mark Twain nailed it.

Having a Stroke Is Easy: It's What Comes After, aka Post-Stroke Psychiatric Syndromes

Ok. So you had a stroke, and now the drama is over? Wrong! As I always say, having a stroke is the easy part compared to what comes after. There are 7 conditions named here.

In an article in Psychiatric Times, the drama is simply unfolding. 

The researchers say the most commonly reported of these in the studies are:

1. post-stroke depression (called PSD as opposed to PTSD ((Post Traumatic Stress Disorder)) which ALL stroke survivors have) and 

2. post-stroke dementia (PSDem), which may affect mood and cognitive symptoms. The researchers say that assessment of the survivor's living situation, level of support, and attention to caregivers' and family members' behavioral observations are necessary with patients who have cognitive impairment or other neurologic impediments to communication. 

A higher risk of PSD has been found in patients with "left-sided cortical and basal ganglia lesions and to lesions closer to the frontal lobe than to left posterior or right frontal lesions." (This is why I say--all the time--to get as much information from your doctors as possible in regard to what exactly happened to your brain). 

PSD may involve a spectrum of mood disorders,  "vascular depression," and dementia-related depression. (Vascular depression often predating stroke is associated with higher degrees of cognitive impairment). Because these relationships between depression and dementia are currently vague, the physician should offer treatment of PSD early in the post-stroke period to strengthen mood and cognitive function.

Most reviews have found the risk of PSD to be between 20% and 79% for up to 18 months post-stroke, and the risk of depression is nearly twice that in persons who have not had a stroke. Untreated patients are at risk for chronic illness (even after 2 years) although patients with PSD may recover spontaneously within 12 months with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and psychostimulants (methylphenidate).

PSDem symptoms include poor social judgment, amnesia, cognitive disorganization, language deficits, apraxia, disinhibited and/or unsafe behavior, paranoia, and visual-spatial dysfunction. Thoughts of suicide have been reported up to 24 months after stroke. Patients with PSDem should be followed up monthly, with reassessment of cognitive examination, repeated depression inventory, and screening for psychotic symptoms.

3. Post-stroke mania is rare, but it may be associated with right-sided stroke. Manic symptoms include decreased need for sleep, expansive and/or irritable mood, increased goal-directed activity, disregard for social constraints, recklessness, talkativeness, racing thoughts, excessive laughter or giggling, and poor judgment. Persons with post-stroke mania should routinely be referred for psychiatric care.

4. Anxiety symptoms include episodes of panic, excessive sweating, worrying, and decreased sleep. Risks of 26% for men and 39% for women have been found in a post-stroke anxiety disorders study. A combination of anxiety and depression may be more usual in left cortical stroke, while depression without anxiety may be more usual in left subcortical stroke.

Here's a tip: Avoidance of benzodiazepines is important. These agents may cause cognitive decline, verging on PSDem. Follow-ups should be done in monthly increments. 


Less frequently seen post-stroke psychiatric symptoms include pathologic crying and pathologic laughter (PBA), apathy, and isolated fatigue. 


5. Pathologic laughter and crying are sometimes grouped as pathologic emotions (PE, another name for PBA) with sudden bursts of either laughter or crying, despite of the mood state. 

6. Apathy in the absence of depression may be difficult to evaluate, but it's a complete lack of initiative without tearfulness, sleep/appetite disturbance, hopelessness, or suicidality.

The use of psychostimulants for PSD or apathy, sometimes both, may be associated with a risk of seizure and/or cardiac side effects. Concern for these risks must be balanced against undertreatment of PSD. In cases of cardiac disease, consultation with a cardiologist is best with careful dosing of psychostimulants.

7. Post-stroke psychotic disorder symptoms include delusions, hallucinations, thought disorganization, and regressed motor behavior. Post-stroke psychotic disorder has been shown with right-sided lesions and cortical/subcortical atrophy. Persons with post-stroke psychosis should be referred for psychiatric care. A patient with pre-stroke psychotic illness, such as schizophrenia, may ultimately decline following a major stroke.

Having a stroke is the easy part. It's what comes after that's usually a bitch. 

Why You Lose Memory from Brain Injury and Possible Ways to Improve It

This post is for everyone because you never know when you’ll suffer a brain injury. I had a stroke. And with that may come memory loss. I want to say I learn something new every day. In reality, I don't, but pretty close to it. Researching and completing this post over a 2-week period taught me many things about memory, and I'll share them with you. 

Memory is defined as: the faculty of the brain by which information is encoded, stored, and retrieved when needed, vital to experiences, and is the retention of information over time for the purpose of influencing future action. 

Let's get academic for the moment if we haven’t already. This from LumenLearning:

• It is theorized that memories are stored in neural networks in various parts of the brain associated with different types of memory, including short-term memory, sensory memory, and long-term memory.
• Memory traces, or engrams, are physical neural changes associated with memories. Scientists have gained knowledge about these neuronal codes from studies on neuroplasticity.
• Encoding of episodic memory involves lasting changes in molecular structures, which alter communication between neurons. Recent functional-imaging studies have detected working-memory signals in the medial temporal lobe and the prefrontal cortex.
• Both the frontal lobe and prefrontal cortex are associated with long- and short-term memory, suggesting a strong link between these two types of memory. Damage there is monumental.
• The hippocampus is integral in consolidating memories but does not seem to store memories itself.

For all those who know what part of the brain-sustained damage, and you should demand to know by asking your doctor, the following descriptions of the different types of memory will be useful to determine where your loss is according to where it's positioned. 

• Sensory Memory: 

Brain part most relevant: Temporal and  Occipital lobes 
The ability to retain impressions of sensory information after the original stimuli have concluded and the shortest-term element of memory through the five senses of sight, hearing, smell, taste and touch, which are retained accurately, but very briefly. 

• Short-Term Memory:

Brain part most relevant: Pre-Frontal Cortex, Frontal, and Parietal lobes 
Short-term memory is followed hand-in-hand with sensory memory and allows the ability to hold on to a piece of information temporarily in order to complete a task or remember directions, for example.

Long-Term Memory:

Brain part: Frontal and Temporal lobes 
Long-term memory allows the ability to decode information, create associations among an object’s various properties, and develop opinions.

(For Sensory and Long-Term Memory: The Temporal lobe is where lies the hippocampus, a small organ which forms an important part of the limbic system, the region that regulates emotions and events that happened in the past. Needless to say, it's complicated).

And this from McGill U in Canada:
In regard to long-term memory, researchers found two types: 

Declarative memory, aka explicit memory, is what happens when you recall your birthday or what you recall eating last night. You can name and describe each of these remembered things explicitly.

Non-declarative memory, aka implicit memory, is like riding a bike or tying your shoelaces, where you do things, most often motor skills, that do not require the use of language.  

Here's the bottom line: sensory memory leads to short-term memory which leads to long-term memory. If anything is going on where the process is interrupted, you will have some sort of memory issue.

Another study by researchers at the University of Queensland in Australia found out that, relative to short term memory, using magnetic resonance imaging (MRI) machines, people perform tasks requiring them to hold information, such as the location of a flash of light, and the PFC (pre-frontal cortex) becomes active. In terms of the sides of the brain, the left is more involved in verbal memory while the right is more involved in spatial memory, such as recalling where the flash of light happened. 

So can you do anything to get your memory restored? It depends. The amount of damage is certainly important.  

One study said practicing meditation, drinking coffee (albeit before 2pm if you have trouble sleeping at night), eating berries (blueberries are high in flavanoids), chewing gum (because it may improve concentration), and doing exercise (the brain is stimulated) can help improve memory. But the most important? Getting enough sleep.

A study reported on memory- challenged participants to memorize illustrated cards, testing their memory. Then they had a 40-minute break--one group napped and the other stayed awake. After the break, both groups were tested on their memory recall of the cards. Surprisingly, the group who had napped performed better, retaining on average 85 percent of the patterns compared to 60 percent for those who had remained awake.

On the other hand, the brain is the least understood part of the human body. But practicing meditation, drinking coffee, eating berries, chewing gum, doing exercise, and getting enough sleep are harmless, and one or some of those activities may do the trick. 

You know what I always say: if it works, use it. 

Everything Happens For a Reason? Utter Nonsense!

Once in awhile, you hear somebody say, when something disastrous occurs, "Everything happens for a reason." (And its corollary: It's a blessing in disguise. Ugh.) I used to say it, too. But now, it brings up thoughts of infants dying of SIDS, of good people having a fatal disease, of innocent folks experience a mudslide without insurance. Why would anything happen to them!

 

I believe in God, albeit an agnostic right at the edge, but I believe it's a random occurrence for how things shake down. It's all bad luck. Don't fool yourself. It's not "God's plan." How could it be!

Canadian philosopher Dr. Paul Thagard says, "For some people, thinking this way makes it easier to deal with relationship problems, financial crises, disease, death, and even natural disasters such as earthquakes. It can be distressing to think that bad things happen merely through chance or accident. But they do."

Adversity strategist Tim Lawrence writes, “Some things in life cannot be fixed. They can only be carried.” 

Freelance journalist Nicholas Clairmont argues, "'Everything happens for a reason' is my very least favorite thing for someone to say."

The list is endless. Can they all be wrong? 

Let me give you some scenarios when "Everything happens for a reason" is said most--when some friend is going through a relationship break-up and you say, "Everything happens for reason." It's ridiculous. Fucked up. Or when somebody lost all their retirement money in a scam. Or when somebody lost a child. Egads, person! Everything happens for a reason? Get real!

The event that changed my mind forever in not saying "everything happens for a reason" was my stroke on April 8, 2009. I had low cholesterol, low blood pressure, no diabetes, and participated in none of the life choices people make to cause a stroke to happen. I couldn't have prevented a stroke anyway because as it turns out, I had "S protein deficiency" that  is a disorder of blood clotting. People with this condition have an increased risk of developing abnormal blood clots. And I had clots in every limb. 

"Everything happens for a reason" was said by a friend, M, when I had the stroke, two months after.

"Look what it did! Everything happens for a reason because if you didn't have a stroke, your book [The Tales of a Stroke Patient] wouldn't have been written."

I thought, What a moronic thing to say. I am an author,  having written a book and articles before my stroke. I hid in the bathroom for about an hour, sobbing, dry heaving, and thinking she's a stupid jerk. I imagine she felt better, thinking that expression was kind, giving me cause to write, but I felt so much worse. I would write some other book. 

So why even try if it's God's plan anyway? How about if you cruise through life on a shoestring budget because if it's God's plan, why bother? Those words are blasphemy to some, but if there really is God, and I think there is, why wouldn't He want the best for everyone? 

These are God questions that I asked in elementary school, sixty and some odd years ago. I still have no answers about God and His plans. But "everything happens for a reason" is bullshit. I answered that 10 years ago.