When I was 12, my parents bought me a transistor radio for my birthday--no headphone output and only AM. That was good enough because I didn't know any better. I listened to broadcasts of WIBG and rock 'n roll aficianado Hy Lit before school, and the same channel again in the late afternoon after I got home until bedtime. I used to joke that the transistor radio was surgically attached to my ear. My parents, who were Tommy Dorsey fans from the 40s, couldn't understand the words the maniacs (their words, not mine) were singing. But I understood all of it.
I was married at 21, but still took my transistor radio with me everywhere, like in the summer to the apartment's pool where I blasted it to the Mamas and Papas and Credence Clearwater Revival and Hall and Oates. My husband was not a music fan and called the singers maniacs, too. The next year, the transistor radio went in the crawl space along with my beloved dolls because I was all grown up. And I upgraded to the boom box.
I always loved music and that's why I loved playing the piano, by ear where I could play anything that was written. Those days are gone now because of my stroke, and with it a paralyzed arm, but I still tap my foot to the music. In therapy, for instance, when I’ll have have my eyes closed and the therapist always comes over to me in fear that something's wrong. I'll open my eyes for a brief moment and say, "I'm not having another stroke. I'm just in the zone." You'd think the therapist would get it by now. Then I close my eyes again and groove with the music. It doesn't matter what genre--soft rock, hard rock, country. I love the musicmakers. So I wasn't surprised that music therapy has evolved to accommodate conditions like stroke, schizophrenia, heart conditions, and many more.
Medical News, an online mag, reported that music, in a positive way, affects the brain in social interactions and emotions, like less anxiety and reduced depression, giving people "quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization." Medical News also reported current research that suggests when traditional therapy is used with music therapy, it boosts the chances of success significantly in allowing the patient--inpatient or outpatient--positive emotions and motivation. One study concluded that there was "a decrease in blood pressure, heart rate, and levels of anxiety in heart patients." Source: http://www.news-medical.net/health/Music-Therapy-for-Stroke.aspx
Here's why: music has been shown to affect portions of the brain pertaining to control of muscles, mood, speech, cognition, and motivation. Research by Atasu Nayak, MD, has shown that music therapy is linked to a decrease in depression. Nayak and his group also found the more dysfunctional an individual's social behavior was at the beginning of treatment, the more likely the outcome that music therapy would be beneficial. Barbara L. Wheeler, PhD, et al found that group music therapy sessions boosted the ability of stroke patients responded to social interaction, and individual sessions assisted with motivation for treatment. (Aretha Franklin's, toe-tappin' "Respect," please).
Rita Safranek, a writer in 2011 for Discovery Guides, said that stroke victims who participated in music therapy recovered functionally better than those who had not. She goes on to say that notions of music therapy exist in written texts dating back to ancient Greek civilization.
In the last century, after World Wars I and II, musicians routinely visited veterans VA hospitals in the US to make music for those suffering emotional and physical hardships. In the late 1940s, Safranek said, the patients’ responses to music led the medical staff to ask that facilities hire musicmakers. As a result, the request grew into a college curriculum for music therapists.
Thus, the inevitable American Music Therapy Association (AMTA) came to be. The association’s membership is around 4,000 AMTA-certified professionals in the US. The first music therapy degree program was begun at Michigan State University in 1944.
Around 70 colleges and universities in the United States now offer a bachelor’s degree programs in music therapy. Persons who complete an undergraduate degree in music therapy and subsequent clinical internships
are then eligible to take the Certification Board for Music Therapists’ national examination. Several colleges and universities offer advanced degrees as well.
Like all therapists, music therapists have to have goals like the patient writing music, playing a drum, and exercising to upbeat music. Since 1944, Medicare has been examining those goals and has identified music therapy as a reimbursable expense under benefits for hospitalization programs. The ever-growing requests for music therapy, and the ever-increasing research that supports music therapy, have created helpful third-party reimbursement for music therapy services.
"There is a pretty strong research foundation for music therapy," says Al Bumanis, Director of Communications for the AMTA. He says that music therapy can assist stroke patients to get their functioning back by rhythmic exercises, like walking in time with the music and singing to restore speech.
In the same vein, Oliver Sacks, a neurologist and author, wrote Musicophilia, a book music's ability to migrate us out of depression and about dancing to its beat. A review offers the following: Musicophilia offers mind-blowing stories of people of the powers of music "from a man who is struck by lightning and suddenly inspired to become a pianist at the age of forty-two, to an entire group of children with Williams syndrome, who are hypermusical from birth; from people with amusia, to whom a symphony sounds like the clattering of pots and pans, to a man whose memory spans only seven seconds — for everything but music."
For 7 weeks after my stroke in 2009, I stayed at the state-of-the-art Bacharach Institute for Rehabilitation, a world renowned New Jersey rehab facility (alluded to negatively as 'Rehab X' in my book, "The Tales of a Stroke Patient"). I asked the doctor all the time whether I'd play piano again. She knew I had the music gene, but even so, I was never afforded music therapy at Bacharach. There wasn't even background music playing. I couldn't tap my feet.
No music therapy? It's not an option. It's a necessity.
I once went to a chiropractor. I thought he was nuts, and I thought I was nuts to let him manipulate my neck. So it didn't happen. He charged me 95 bucks for an evaluation because only in certain limited circumstances is chiropractic covered by insurance. Before I reveal the relationship between chiropractors and strokes, it's background time, to put chiropractors, bless their crazy, little hearts, in proper perspective.
D.D. Palmer, a teacher, grocery man, and magnetic healer who once said that manipulation is the cure for all diseases for the human race, founded chiropractic medicine in 1895, attempting to merge science and metaphysics, i.e., an offshoot of philosophy that studies the bottom-line structure of reality, or from Merriam Webster's dictionary, "of that which is real, insofar as it is real," and based on its tenets of naturalism, magnetism, spiritualism, voo-doo (just kidding about the voo-doo), and other things that couldn't be proved by scientific methodology. Palmer's chiropractic treatise on spinal manipulation likened the body to a machine whose disguishable parts could be aligned and ultimately fixed, using no drugs.
Calling himself a self-proclaimed doctor, "Dr." D.D. Palmer built a magnetic healing facility in Davenport, Iowa, upsetting a writer at a local paper who said, "His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…. His increase in business shows what can be done in Davenport, even by a quack."
The contention didn't stop Palmer. After a long battle that started in the early 1900s, the philosophy of chiropractic medicine has given society a mixed bag of chiropractors which, said Joseph Keating, Jr., a disciple of Palmer's, in Keating's book, Philosophy in Chiropractic, "Despite their emphasis of manual therapy, [chiropractors] may vary on their perceived scope of practice, interventions and their role in the health care system." And there it is. That's another way of saying that chiropractic medicine has few protocols regarding how the chiropractic industry operates.
As far back as the 1960s, the American Medical Assiciation (AMA) announced that chiropractic medicine was an "unscientific cult." That decade also brought the AMA Board of Regents' "Committee on Quackery" with the principles of eradicating chiropractic medicine to ensure that Medicare should not cover chiropractic services. (They still don't cover much today). Every decade after brought refinement and more allowed services to chiropractors and those that seek chiropractic care. Still, many medical professionals, orthopedists in particular, do not recognize the chiropractic profession at all. And most doctors don't validate, if they validate it at all, chiropractic medicine for children.
In every state in the US, there's been suits against chiropractors for one
thing or another. Let's go through a sample in the recent past:
In West Virginia, a chiropractic firm was found guilty of insurance fraud, in convincing new patients that they had serious spinal conditions, even if they did not;
In Kentucky, "Dr." Paul Hollern taught his student chiropractors to sell patients needless services.
In Texas, an accident clinic was found guilty of overtreatment and unnecessary referrals.
In New Jersey, insurance fraud busted people, including chiropractors, for involvement in "staged" accidents.
In Illinois, ten Chicago area chiropractic clinics and five chiropractors, among others, were charged with the unlicensed practice of medicine, illegal self-referrals, fee splitting, and inflated and false medical claims.
In California, a bunch of chiropractors got indicted on charges that they were involved with massage-producing prostitutes.
In Florida, charges were brought against a chiropractor and others who allegedly committed social security fraud and insurance fraud where the insurance companies were billed for massages.
Sharon Hill, an Australian writer for Doubtful.com, who mission is to expose "quacks," zeroed in on many, uh, let's say, questionable techniques that chiropractors have used, some as recently as late as least year. She has written about actions taken against chiropractors who have no business, according to Hill, doing what they do. Hill covers the gamut, like a "cure" for diabetes in her August 26, 2013, edition. "Diabetic Solutions MD promises it can help cure diabetes through a step-by-step process and nutritional supplements that could cost you thousands. Don’t be misled by the MD in the title. The doctors pitching the supplements are licensed chiropractors whose practices revolve around marketing supplements and diet plans, Hill says.
And in September 2007, Hill writes, Sandra Nette went in for a neck adjustment and wound up with a stroke. She said the chiropractor forged consent forms after the stroke. She remained in a "locked-in" position, meaning that she unable of walking and barely able to speak or swallow. She was offered an out-of-court settlement for an undisclosed amount. Or these titles: Animal chiropractic: Not all it’s cracked up to be (snakes, too. Snakes?); Chiropractic care for kids called into question; Chiropractors jumping on chance to capitalize on meningitis scare, and more.
All of those cases have some relationship to greed. I agree that I have
cast a shadow over chiropractic medicine and it's not because the chiropractic industry was founded by a grocery man. Hell, some of my best friends are in the grocery business. But there's even a darker side than greed: needless injury leading to strokes.
Science Based Medicine (SBM seen at sciencebasedmedicine.com) says one of the ways chiropractors make big money is spinal manipulation. On June 22, 2013, an article was written called Chiropractic Danger: Neck Manipulation and Strokes. The neck, the article explains, is twisted and turned in certain ways that are meant to reduce or completely eradicate pain. Many patients go back, year after year, seeking shortcuts to the chiropractors assumed with magical hands for some relief.
One report by SBM revealed that a 37-year-old woman had neck adjustment and a stroke ensued. The chiropractor didn't notice the symptoms--primarily weaknesses on one side of the body--after working on her neck. And the Internet is filled with stories like this one. Just Google "neck adjustment stroke" for the hell of it.
From Quackwatch, for example: "Some chiropractors advocate screening tests with the hope of detecting individuals prone to stroke due to neck manipulation. These tests, which include holding the head and neck in positions of rotation to see whether the patient gets dizzy, are not reliable, partly because manipulation can rotate the neck further than can be done with the tests. Listening over the neck arteries with a stethoscope to detect a murmur, for example, has not been proven reliable, though patients that have one should be referred to a physician. Vascular function tests in which the patient's head is briefly held in the positions used during cervical manipulation are also not reliable as a screen for high-risk patients because a thrust that further stretches the vertebral artery could still damage the vessel wall ([aka a stroke])."
And this, from a former chiropractor, Rob Alexander, M.D.: "I have been
doing a vascular surgery rotation for the past month, which is part of my postgraduate medical education. During my chiropractic training, when the subject of manipulation-induced stroke was brought up, we were reassured that "millions of chiropractic adjustments are made each year and only a few incidents of stroke have been reported following neck manipulation." I recently found that two of the patients on my vascular service that suffered a cerebrovascular accident (stroke) had undergone neck manipulation by a chiropractor, one the day that symptoms had begun and the other four days afterward."
Dr. Alexander continued, "If indeed the incidence of stroke is rare, one M.D. would see a case of manipulation-induced CVA about every 10 years. But I believe I have seen two in the past month! I therefore urge my medical colleagues to question their patients regarding recent visits to a chiropractor [who did] neck manipulation when confronted with patients that present with the neurologic symptoms of stroke. I also urge potential chiropractic patients to not allow their necks to be manipulated in any way. The risk-to-benefit ratio is much too high to warrant such a procedure."
And this from SBM's Harriet Hall on April 29, 2008: "I wonder how many people have heard that chiropractic neck adjustments can cause strokes. It isn’t exactly common knowledge. One organization is trying to raise public awareness through signs on the side of city buses (Injured by a Chiropractor? Call this number) and through TV commercials. I had never heard about this phenomenon myself until a few years ago, when I heard it mentioned on an episode of Alan Alda’s Scientific American Frontiers. I questioned accuracy, but I quickly found confirmation in the medical literature."
Hall goes on. "A typical case was that of 24 year old Kristi Bedenbaugh who saw her chiropractor for sinus headaches. During a neck manipulation, she suffered a brain stem stroke and she died three days later. Autopsy revealed that the manipulation had split the inside walls of both of her vertebral arteries, causing the walls to balloon and block the blood supply to the lower part of her brain. Additional studies concluded that blood clots had formed on the days the manipulation took place. The chiropractor later paid a $1000 fine."
Hall proceeds to say that chiropractors are well aware of the risk. "They have attempted to find ways to screen patients for high risk, but there is no reliable way to do so. Strokes are a major reason for chiropractic malpractice insurance payouts – 9% of claims paid by the major chiropractic insurer in 2002, the only year for which I was able to find statistics. Some chiropractors are now asking patients to sign an informed consent form before manipulations. If asked, most chiropractors downplay the risk, saying it occurs in less than one in a million manipulations. Many (perhaps most) chiropractors do not mention the risk at all.... Heat, massage, tincture of time, exercises, and other measures may offer symptomatic relief with no associated risks."
About 4 percent of all ischemic strokes are caused by blockages in the basilar artery system. The basilar artery supplies oxygen-rich blood to some of the most critical parts of the brain. Basilar strokes have been linked to chiropractic medicine. About 20% of all basilar strokes come from spinal manipulations, or about 1300 a year in the U.S. Chiropractic treatments have been proven for carotid artery strokes. If someone dies from stroke, vertebral arteries are not usually examined at the autopsy. In 2002, a study of patients up to the age of 45 who had a stroke revealed that they were 5 times more likely to have seen a chiropractor in the week before the stroke than in the control group. A group of Canadian neurologists issued a statement in the same year urging caution, education, informed consent, and other caveats to protect the public.
And this, from Dr. Stephen Barrett in his article, "Neck Manipulation and Strokes," a piece revised on September 29, 2013: "In 1992, researchers
at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo. The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tares of the carotid arteries."
Dr Barrett added that in 2001, "Canadian researchers published a report about the relationships between chiropractic care and the incidence of vertebrovascular accidents (VBAs) due to vertebral artery dissection or blockage in Ontario, Canada, between 1993 and 1998. Using hospital records, each of 582 VBA cases was age- and sex-matched to four controls with no history of stroke. Health insurance billing records were used to document use of chiropractic services. The study found that VBA patients under age 45 were five times more likely than controls to (a) have visited a chiropractor within a week of the VBA and (b) to have had three or more visits with neck manipulations. No relationship was found after age 45. An accompanying editorial states that the data correspond to an incidence of 1.3 cases of vertebral artery dissection or blockage per 100,000 individuals receiving chiropractic neck manipulation, a number higher than most chiropractic estimates."
Let me say, in defense of chiropractors, they all believe in what they say. And there are bad apples in every profession. But a neck adjustment? From a chiropractic philosophy that was started by a grocer who called himself "Dr"? Heh, heh. That's crazy.
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!
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.
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.
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.
"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.
"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.
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....
