My Upcoming Surgery for Foot Drop, aka My 50/50 Gamble

This may be my last post until my surgery on July 14th. Or maybe not. Anyway, I'll update you as soon as I can on the surgery. As usual, here's some background on the operation.

Ever since the stroke, I developed foot drop (or drop foot--I've heard it both ways), meaning the muscles and tendons that pull the foot and toes up are no longer working substantially. I walk on the side of my foot and the toes are not flat on the ground.

The American Orthopedic Foot and Ankle Society (AOFAS) says, "The surgical procedure for a foot drop is called a tendon transfer. In general, a tendon transfer is a procedure in which a tendon (and attached muscle) that is still working is taken from one part of the foot and moved to another part of the foot to try to replace the muscle function that is missing. The most common tendon transferred is the posterior tibial tendon." 

There's more. A second tendon, the peroneus longus, is severed above the ankle on the outside side of the leg. 

This tendon is then transported to the front of the ankle and the free end "is attached to the posterior tibial tendon and the anterior tibial tendon in a bridle configuration. With this construct, the posterior tibial muscle pulls on all three tendons to pull the foot up. The posterior tibial tendon is routed to the top of the foot as described above," says the AOFAS. Clever, huh!

Here's what it looks like when it's finished:  

Am I scared? Sort of. Anything could happen during surgery: anesthesia going south, infections. But do I have confidence in Dr. Dane K. Wukich? Absolutely!

As his website says, "Dr. Wukich is the chief of the foot and ankle division and associate professor of orthopaedic surgery at the University of Pittsburgh Medical Center. He is recognized nationally and internationally in this field and practices within the UPMC system and the Veterans Administration Medical Center is Pittsburgh. 

"His 80 publications include scientific articles, reviews and book chapters and he has presented over 150 medical lectures during his career. As a board certified orthopaedic surgeon with subspecialty training in foot and ankle surgery, Dr. Wukich is uniquely qualified to treat traumatic, degenerative, congenital and acquired disorders of the lower extremity. His orthopaedic training included comprehensive education in:

Amputations of the Lower Extremity  
Amputation Prevention 
Arthritis 
Biomechanics 
Degenerative Joint Disease 
Diabetes and its Impact on the Foot and Ankle 
Joint Arthroplasty 
Limb Salvage 
Metabolic Bone Disease and its Impact on the
Musculoskeletal System 
Neuromuscular Disorders and Spasticity 
Rehabilitation 
Sports Related Issues and Overuse Disorders 
Trauma"

Dr. Wukich examined my foot and said I am a candidate for this surgery because I have some minimally working muscles in my ankle and foot. If the operation is successful, I won't have to wear the cumbersome brace anymore. The doc said my chances are 50/50. 

How come no one in Philadelphia or South Jersey, where I am from, recommended this surgery? I haven't a clue. But I'm glad I came to Pittsburgh to find this information. 

By the way, Dr. Wukich doesn't know anything about this post. I won't tell him, either. He's a humble man, I think. But people who have drop foot will be educated on what they can do about it. "Options" is my middle name.

So I won't say "goodbye." That word is so final. Rather, I'll say, "See you later." 
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3 months later:
Surgery is a success! No foot drop and my foot is flat on the floor! I'm wearing the brace for now, but who knows what the future will bring? But I'm staying positive and maybe....

Impulses and the Brain, aka Fuck! Where Did My Filters Go?

In 1848, in a report written by Dr. John Harlow, M.D., the doctor related the unfortunate, rock-blasting accident by a railway worker, Phineas Gage, who had a long metal rod blasted through his left cheek, through his eye, and out of the top of his head. Consequently, the accident caused damage to his frontal lobe. 

Gage survived the accident and had his memory, speech, and motor skills intact, but he had well-documented changes to his personality. (The photograph is of brain-injury survivor Gage, 1823–1860, shown holding the tamping iron which injured him).

Before his misfortune, Gage was described as organized, respectful to others, and well-tempered. According to Dr. Harlow, following the accident, he was "fitful, irreverent, indulging at times in the grossest profanity, and manifesting but little deference for his fellows." In other words, he was disorganized, had hissy fits, cursed, and disrespected others. The cause? He had damage to the frontal lobe of his brain.

 
The frontal lobe is so vulnerable to injury because of its location. Damage--any kind at all--to this lobe can lead to one or more of these problems: 

Change in speaking behavior

More or less problem-solving ability and creativity
Impairment of risk-taking activities
Reduction in sense of taste and/or smell
Damage to spontaneity and mental flexibility
Increased susceptibility to distractions 

Finally, after all this time, after more than 5 years, I discovered, through the story of Phineas Gage, why I had no filters after the stroke. But a little background first.

Of all the parts of the brain, the cerebrum or cortex is the largest part, which is further sub-divided into four lobes: the frontal lobe, parietal lobe, occipital lobe, and temporal lobe. (There are other "areas and sections," too, but the lobes are the subject of my focus).

Responsibilities of the frontal lobe: reasoning, planning, organizing thoughts, behavior, sexual urges, emotions, problem-solving, judging, organizing parts of speech, and motor skills

Responsibilities of the parietal lobe: information processing, movement, spatial orientation, speech, visual perception, recognition, perception of stimuli, pain and touch sensation, and cognition 

Responsibilities of the occipital lobe: visual reception, visual-spatial processing, movement, and color recognition

Responsibilities of the temporal lobe: visual memory and verbal memory involved with hearing and speech

My brain damage was in the first and the second—frontal and parietal, the former controlling behavior and emotions when it came to my filters, or lack of them.

I remember it well. After my stroke, as soon as I was mobile, I went out to lunch with my son. It was an Indian place that had a huge buffet. We ate our meal and as soon as the check arrived, we paid at the counter. All of the sudden, a hefty man, who couldn't wait for the food, cut to my right, almost knocking me over.

I began to chant. “Rude.” Then louder. “RUDE.” Then louder. “RUDE!” Then the ultimate. “FUCKING RUDE!” That chanting at the peak went on for about a minute. My son tried to usher me out, but I was transfixed on that spot, with people in the restaurant staring at their plates. The man continued grabbing food from the buffet. That, my friends, is when I knew: my personality, formerly consisting of peace, decorum, and patience, changed--completely. My filters were loose and couldn't be roped it.

Granted, I was aphasic more that first year, more than I am now, but I was off and gone that first year, screaming at receptionists if they didn't understand me, yelling at doctors (yes, doctors) if their opinion was contrary to mine, berating waitresses by repeating my order loudly if they were not in tune with me. I was a mess. I couldn't recognize me, as if there were two of me, one shrieking and the other assessing, all because of the frontal lobe not controlling my impulses.


I am better now, though still not perfect. The word "fuck," "shit," and/or "crap" are always present if I lose my filters for the moment, like "Fuck this" or "Don't be a shit" or "This is crap." Sometimes, I'll combine them as in "Fuck! This shit is crap." 

Sometimes, saying "fuck, shit and/or crap" feels so cathartic. But not all the time, as I did that first year. 

I'm going to have surgery July 14 to correct my dropped foot. I'll write a post about the surgery soon. So if I ever do anything athletic again, I'd wear a helmet. I wouldn't want to damage the frontal lobe again. Fuck no!

TIME TO SIGN FOR MORE STROKE RESEARCH

While I'm actively working on the next post, take a few minutes to sign, won't you? Thanks! You'll be helping millions of stroke survivors around the world achieve more research on strokes!

http://petitions.moveon.org/sign/more-research-for-strokes

Hyperbaric Oxygen Therapy, aka Flooding the Brain with O

The refrain in Willie Mason's song Oxygen has a lot a meaning for me.

On and on and on it goes
The world it just keeps spinning
Until I'm dizzy, time to breathe
So close my eyes and start again anew.

 

That refrain is about rejuvenation, a time of constant do-overs. For me, as a stroke survivor, it doesn't take much to make me happy. Give me air to breathe, a clean outfit with coordinated socks and the self-confidence, or as my grandmother used to call it, chutzpah, to get through yet another day. That's all it takes.

 A lot of people are like me. Worldwide, fifteen million have strokes and more suffer from other traumatic brain injuries (TBI) every year, resulting in psychological disorders, memory loss, and function disabilities. 

So I had the idea to research hyperbaric oxygen therapy (HBOT) because so many people were writing about it on social media sites as a way to improve the disorders, memory, and disabilities. There were personal accounts of people who tried it with success.

The use of hyperbaric therapy is about 350 years old. The first hyperbaric oxygen chamber was erected in 1662 for acute and chronic illnesses. Clinical use of hyperbaric oxygen therapy started in the mid to late 1800s for spa treatments and decompression sickness. However, it wasn't until the 1960s that research was started on a broad spectrum for a multitude of disabilities like stroke, Alzheimer's, Parkinson's, autism, arthritis, learning disabilities, and more.

Specifically, because a lack of oxygen in the brain is associated with stroke, a growing number of doctors, albeit a small number, believe that a way to treat stroke is by flooding the brain with oxygen. Thus, HBOT.

The esteemed Mayo Clinic writes, “Hyperbaric oxygen therapy typically is performed as an outpatient procedure and does not require hospitalization. If you're already hospitalized and require hyperbaric oxygen therapy, you'll remain in the hospital during a hyperbaric oxygen therapy session." 

Alternately, you may be transported to and from the hospital to a hyperbaric oxygen therapy session if the procedure is performed at an outside facility.

Depending on the type of medical institution you go to and the reason you require treatment, you may receive hyperbaric oxygen therapy in one of two settings:

• A unit designed for one person. In an individual (monoplace) unit, you lie down on a padded table that slides into a clear plastic tube about 7 feet long.
• A room designed to accommodate several people. In a multiperson hyperbaric oxygen room — which usually looks like a hospital waiting room inside — you may sit or lie down. A lightweight, clear hood may be placed over your head to deliver the oxygen to you, or you may wear a mask over your face to receive the oxygen.

The hyperbaric oxygen therapy increases the air pressure in the room is approximately to two or three times normal air pressure, creating a feeling of stuffiness in your ears, comparable to what you might experience in a plane on ascent or descent. 

HBOT may last from one to two hours with a technician monitoring you and the therapy unit during treatment.  

Lightheaded-ness after the treatment is not uncommon. Usually, the feeling disbands within a few minutes. 

The Mayo Clinic uses HBOT for: 

• Bubbles of air in your blood vessels (arterial gas embolism)
• Decompression sickness
• Carbon monoxide poisoning
• A wound that won't heal
• A crushing injury
• Gangrene
• Skin or bone infection that can cause tissue death
• Radiation injuries
• Burns
• Skin grafts or skin flaps at risk of tissue death
• Severe anemia

But, says the Mayo Clinic, “more research regarding hyperbaric oxygen therapy is under way," so there's insufficient scientific evidence to support claims that hyperbaric oxygen therapy can effectively treat the following conditions:

• Allergies
• Arthritis
• Autism
• Cancer
• Cerebral palsy
• Chronic fatigue syndrome
• Cirrhosis
• Fibromyalgia
• Gastrointestinal ulcer
• Stroke 

At around the same time that the Mayo Clinic wrote those disappointing words, I read this article that came out in Israel. Dr. Shai Efrati and Professor Eshel Ben-Jacob of Tel Aviv University's Sagol School of Neuroscience confirmed that it is possible to repair brains and thus add to the quality on life for TBI victims, including strokes, even a long time, years even, after the TBI occurred. 

Despite the often dismissive position of the Centers for Disease Control and Prevention, United States Food and Drug Administration, and the medical field as a whole, Dr. Efrati, Professor Ben Jacob, and their collaborators had research behind them.

In a clinical trial, including 56 participants who had been traumatized by TBIs and were still encountering headaches, concentration problems, other cognitive disabilities, the patients' symptoms were ongoing before HBOT.

The participants were divided into two groups in random fashion. One group had the benefit of HBOT treatment for two months while the other, known as the control group, was not given HBOT at all. The patients' brain activity was then assessed by computerized scans and compared with single photon emission computed tomography (SPECT) scans. 

"What makes the results even more persuasive is the remarkable agreement between the cognitive function restoration and the changes in brain functionality as detected by the SPECT scans," said Ben-Jacob. "The results demonstrate that neuroplasticity can be activated for months and years after acute brain injury."

"But most important, patients experienced improvements such as memory restoration and renewed use of language," Dr. Efrati noted. "These changes can make a world of difference in daily life, helping patients regain their independence, go to work, and integrate back into society. This is where HBOT treatment can help." 

It all started to make sense. Elevated oxygen levels during treatment would supply the energy for aiding the healing process. 

 

Israel is progressive. The Israelis knew that marijuana was good for some illnesses causing pain and seizures before we knew about it. (Or before I knew about it). Also, the Israelis discovered: 

• digitized mammography which shows sub-millimeter details
• 3-D mapping in the diagnosis of heart conditions 
• combined electro-optical laser and conventional optical instrument for the diagnosis of ocular pathologies
• a laboratory appliance that can sort chromosomes, cells or tissues by colors, thus designating genetic abnormalities
• diagnostic equipment for sleep disturbances

Good stuff. Good for them. Good for us. L'chaim.

Fatigue and Stroke, aka I'm Hittin' the Wall

(This post is not only for stroke survivors. It is for caregivers, family, friends, health professionals, and others who want to understand fatigue and stroke).

I always pushed myself to the limit. I was like my father, who was shot in his auto parts store by some robbing druggies in 1971 and died on the spot, putting an end to his boundless energy. He worked twelve hours a day, seven days a week, and yet, when he returned home, he ate dinner at 8pm, and sometimes went out again, and always on the weekends, with my mother, who was a stay-at-home mom and had to deal with my boundless energy.

But now that I've had a stroke, my energy has boundaries. All my friends will tell you. I get an entire list of the things I want to do in a day, but I'm always changing the schedule because when it comes to the list, I'm just too damned tired to finish all of it. Why is that? I wanted to know, and I found out a whole lot.

Everybody feels tired at some point. It's the body's way of saying, "Slow down and rest awhile." But the National Stroke Association (NSA) says that post-stroke fatigue (PSF) affects as much as 70 percent of stroke survivors. PSF happens without warning and happens as much as years after the stroke. PSF is not just feeling tired and wanting to take a nap. With PSF, you have to take a nap.





The NSA identified 3 types of fatigue for stroke survivors:

Cognitive (ex: mental fatigue, difficulty focusing, delirium)
 

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

Emotional (ex: motivational deficits, depression, crying and laughing at odd intervals)

I encountered all of them. On the cognitive side, I still have mental fatigue and usually rest once a day; just resting, not necessarily napping. I seldom have difficulty focusing, and deliriums only the first year. I have all of the physical ones randomly, except for function limitations all the time. I have right-sided weakness—a paralyzed arm and I walk with the aid of a quad cane. As for emotional fatigue, I am still, somehow, motivated, but I had depression the first year and off and on since then, and less now. I cried and laughed at the wrong times and places, but that confusion went away after two years.

Aside from different types of fatigue, some medications may point to or worsen fatigue. The medication dosage, the time of day of the medication, or the actual medication itself may need to be adjusted.

Be aware of time and place. Loud stimulation such as music and crowds can be overwhelming for a stroke survivor and bring on fatigue. Some survivors keep a diary of the times a places where fatigue occurred--hand-written or recorded--and if that's so, don't take this diary lightly. Remember, a stroke survivor doesn't want to take a nap; they have to take a nap.

Look for which activities have the greatest impact on stamina, or energy level. (The ones in parentheses are my reactions). Is it watching a sports events? (If the team is winning, go team!) Going shopping? (Absolutely nothing gets in the ways of shopping, especially for clothes). Having a meal? (I didn't fall asleep during a meal. Ever).

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

1.   Walnuts
2.   Pumpkin seeds
3.   Quinoa
4.   Yogurt
5.   Whole grains
6.   Wheat bran cereal
7.   Red bell peppers
8.   Tea
9.   Watermelon
10. Dark chocolate

But listen up! Every stroke, just like snowflakes, as the yarn goes, is different. As for me, once I found this list a while ago, I eat them all except pumpkin seeds. They make me cough. And I don't take as many naps every day since.

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

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

In an article entitled “Post-stroke Rehabilitation: Fatigue After Stroke,” Ed Koeneman says, “The medical conditions of a survivor, such as diabetes, heart disease, anemia, respiratory disease, migraines, or pre-stroke fatigue can contribute to a [stroke] survivor's post stroke fatigue. This is because the stroke itself or the side effects of stroke medication may worsen the survivor's fatigue.

"Sleep apnea is also relatively common among stroke survivors and is reported in high rates among individuals who report fatigue after stroke. However, no solid relationship has been proven," says Koeneman.
 

 And there it is--"no solid relationship has been proven." My belief is that stroke fatigue falls to the back burner, but use the suggestions in this post. They may help. One reader, a stroke survivor, wrote, “Every time I turn the television on and water the plants with one hand simultaneously, I get re-energized.” Good for you, C.L. Whatever works.
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In collaboration with http://www.just-health.com.au

The Yin and the Yang of Vaccinations and Strokes

Vaccines have been hurrah-ed as one of medicine's top success stories which have eliminated a host of dastardly diseases in the US. And stroke in childhood is very rare, affecting about 6 in 100,000 per year, according to the National Stroke Association. So what's the connection between vaccinations and strokes? It all comes down to the ying and the yang.

The Yin

In an article entitled “Vaccine-induced strokes on the rise among young people,” published by Natural News, Heidi Stevenson writes that vaccinations are “the elephant in the room” when it comes to a factor for so many younger people getting strokes.

In October 2007, the American Academy of Neurology published a report and found that “between the years of 1993 and 2005, the stroke rate among individuals under the age of 55 increased by more than 44 percent.” Many health professionals said lack of exercise and poor dietary habits might play a factor as well. But vaccines might contribute, too, says Stevenson, with causing seizures and strokes in the young as well.

"A range of neurological disorders [is] associated with vaccines, including macrophagic myofasciitis, encephalopathy, epilepsy, convulsions, Guillain-Barre syndrome, nerve deafness, blindness, paralysis, sudden infant death syndrome, and of course, autism," writes Stevenson. "Now that the earliest recipients of mass vaccination programs are entering middle age, why should we be surprised to find that they're more likely to suffer from another indication of brain damage, stroke?"

A Canadian doctor, Andrew Moulden, who has been in practice for close to 30 years, uncovered the truth before Stevenson. Dr. Moulden discovered that in 2001, vaccines can promote microvascular strokes in some people. Though the news never came to light and was never published in any medical journals, vaccines cause the body's immune system to reject vaccines which prompts a huge release of white blood cells.

And this influx of white blood cells, says Dr Moulden, “are too large to enter the bloodstream, surround capillaries, and actually clog and/or collapse them, leading to what are essentially micro-strokes. As a result, these blockages prevent smaller red blood cells from effectively delivering oxygen to the organs [ie, the brain, for example] near these capillaries.”

Says Stevenson, “What should be clear by now is that vaccines are taking a severe toll on people's brains. The cost both to the individuals, whose lives are affected by strokes, and to society as a whole, which loses productiveness and is burdened with their care, is massive."

The Yang

In an article entitled Vaccines reduce risk of strokes in children, children who received some, few or no vaccines were nearly “seven times more likely to have a stroke than kids who had all or most of their recommended shots,” according to Dr. Heather Fullerton, a professor of neurology and pediatrics at the University of California, San Francisco, and presented the findings of the study at the American Stroke Association's International Stroke Conference in San Diego.

“Pediatric strokes are rare,” says Dr. Fullerton. And to bolster her argument, Fullerton says research has shown that infections greatly increase a child's risk of stroke, partly by causing a temporary increase in the blood clotting. "The exciting thing about this [Fullerton] study is that with vaccination, it might prevent these strokes from happening," neurologist M. Shazam Hussain says, director of the stroke center at the Cleveland Clinic.

Robert Brown, the Mayo Clinic College's chair of neurology, called the study's findings "remarkable. To lower the risk of stroke is noteworthy. And while strokes in children are rare, these are precious young children who are having these strokes, which affect them throughout their long, long lives."

Leaders of the international study, Vascular effects of Infection in Pediatric Stroke, or VIPS, interviewed the parents or guardians of 310 children who had a stroke with 289 children who hadn't. The children, who were around 7 or 8 years old, were from 40 centers on five continents, and is the most renowned study on pediatric stroke funded by the National Institutes of Health. The study concludes that children who received some, few or no routine vaccinations were almost seven times as likely to have a stroke than those receiving all or most vaccines. 

So what do you do as parents? Vaccinate or not? If the National Institutes of Health and other studies are valid, and my guess is they are, with children who received "some, few or no routine vaccinations were almost seven times as likely to have a stroke," how could you  not?

As with everything, there are laws. According to the Yale Journal of Health Policy, Law, and Ethics, the federal government recommends that all children between birth and age eighteen years receive seventy doses of sixteen vaccines.  Of these recommended vaccines, the majority of states require between thirty and forty-five vaccine doses for children to be able to attend school. Forty-seven states require preschool-age children to receive three doses of the hepatitis B vaccine to attend public school. The federal government recommends that infants receive their first dose of the hepatitis B vaccine shortly after birth, while they are in the hospital. 

Every state and its requirements for immunizations are listed at http://www.immunize.org/states.

A nonpartisan, nonprofit website, http://vaccines.procon.org, presents facts, studies, and pro and con statements on questions related to whether or not vaccines should be required for children. In its Did You Know segment, it offers these statements:
 

Did You Know?

All 50 states require vaccinations for children entering public schools even though no mandatory federal vaccination laws exist. All 50 states issue medical exemptions, 48 states (excluding Mississippi and West Virginia) permit religious exemptions, and 20 states allow an exemption for philosophical reasons. Over 5,500 cases alleging a causal relationship between vaccinations and autism have been filed under the National Vaccine Injury Compensation Program in the US Court of Federal Claims between 2001 and 2009. The US Court of Federal Claims Office of Special Masters, between 1988 and 2009, has awarded compensation to 1,322 families whose children suffered brain damage from vaccines. About 30,000 cases of adverse reactions to vaccines have been reported annually to the federal government since 1990, with 13% classified as serious, meaning associated with permanent disability, hospitalization, life-threatening illness, or death. According to a 2003 report by researchers at the Pediatric Academic Society, childhood vaccinations in the US prevent about 10.5 million cases of infectious illness and 33,000 deaths per year.

There's really no choice. How can you not?

Beware, Fat People! A Stroke Might Be A-Comin'!

People are so touchy at times. You have to say things “PC”, aka politically correct. You say the wrong word to describe them--fat, stupid, lazy, even if that description matches, and bingo! They won't talk to you, sometimes maybe never again. But the difference between me and them is, now I don't care. And as a result, some people don't like me. With the stroke, I have no filters—altogether.

A long time ago, when I was little, I did mind if anybody called me chubby, which I was, until about seventh grade when I got self-conscious, right on schedule. 

Clothes used to come in regular and chubby sizes. I took a chubby size all the way through elementary school. I didn't know any different because I had a fat brood—my immediate family, uncles, aunts, cousins, fat people whatever way I turned. The truth is, I loved to eat because I didn't know any better. Eating a lot used to equate to love. 

The fat that I once had doesn't have any bearing on the stroke I now have, or does it? But if you're overweight, morbidly obese, chubby, pleasantly plump—call it what you want—you may be in trouble.

The National Stroke Association says that obesity can put stress on the whole circulatory system. And a recent Harvard University study found that you could cut your stroke risk by
30 percent by eating five daily servings of fruits and vegetables instead of fries, chips, alcohol, and soda. 

Citrus fruits, broccoli, and cauliflower are noted as particularly helpful. It may be their higher concentrations of potassium, folic acid, and fiber are the clues.

The American Heart Association (AHA) “recommends at least 60 minutes of physical activity a day for kids.” The AHA also “recommends that adults get at least 150 minutes of moderate or 75 minutes of vigorous physical activity a week.” If you're fat, you can make time. You just don't want to. You're a creature of the fat habit.

Individuals who are obese have a greater chance of succumbing to sleep disordered breathing, known as sleep apnea. And those with sleep apnea have a greater risk of stroke.

Ok. Need more evidence? A study by researchers at Columbia University say that people with abdominal obesity are at higher risk of ischemic stroke, the most common kind of stroke, caused by blockage of a blood vessel in the brain.

Most of the weight loss articles mention BMI, or body mass index. I'll tell you a simple way to tell if you're overweight if you haven't seen the fat already or you need further proof. The National Institute for Health, aka NIH, has a meter located at http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. When you give your height in feet and inches and your weight in pounds to the NIH, it gives you guidelines for where you are in the BMI range:

• Underweight = 18 and below
• Normal weight = 18.5–24.9
• Overweight = 25–29.9
• Obesity = BMI of 30 or greater

So I did it. I found out, thinking I was normal weight, that I fall into the normal weight range, just by a smidgeon. I tried another scale, this one from the Centers for Disease Control and Prevention, http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/results_overweight.html. Same result. I was shocked. Just a smidgeon? Seriously?

And one more thing. Being overweight and having a stroke is just too much at times. When I gorge, I watch myself over the next few days. It's like you can tell you've gained weight without a scale to remind you. It's the extra pounds that add to the baggage you have to lug around in the first place.

I could fool those old-time types on the Boardwalk and at county fairs that could guess my weight and give me a prize if they were crazy off the mark. I think that old saying is true, for me at least: "You carry your weight well." And that expression needs to be addressed.

Empathy and Sympathy: There's a Difference

I have a confession to make. I'm nosey, probably because I used to be a reporter. I listen in on everything—a cell phone call, restaurant chatter, a conversation between folks sitting on a bench. Then my imagination takes over and I think I'm a reporter again, creating all sorts of scenarios for why the talk happened in the first place. That process keeps my mind sharp, or as sharp as it can be for someone with a brain injury from my stroke.

One time, I was listening in a restaurant to two college students having coffee in the next booth, discussing the project that they were tasked to accomplish: the difference between empathy and sympathy.

“I need an “A” on this project,” the one girl said, “in order to appease my parents. They said if a get all "A's," they would buy me a car.”

“I should get an 'A,' too, in order to stay in school,” the other one lamented.

I couldn't help it, now that I have no filters of any kind since my stroke. I got the attention of one of the girls and said, “Empathy and sympathy? I could help you with that.”

I, who was having a grilled cheese bagel and tea, and my friend, who was eating a Reuben sandwich--corned beef, swiss cheese, cole slaw, and Russian dressing—and a Coke, slid over to make room for the girls who now came to join us, bringing their coffee in tow.

I thought they were desperate to know because one girl had a car at stake and the other would be in deep doo-doo if she failed the course. And they were just too young to know the difference. I proceeded to tell them, and they had their paper and pens ready to take notes.

“Empathy is comprehending what others are feeling because you were in their shoes yourself or have the ability to put yourself in their shoes. Sympathy is providing comfort when some life-changing event occurs to others.

“Empathy and sympathy are both feelings. You can send somebody a sympathy card and forget it. It's just an act of kindness, often impersonal. But with empathy, you get right to the heart of the matter, with thoughts of experiencing the situation yourself.”

And then, I showed some pictures which I had saved from my lecture long ago.

Empathy:

Sympathy:

Even though they were years younger than me, around 50 years or so my junior, they were smart enough to comprehend.

One of the girls, who was promised a car if she achieved all "A's" asked, "So empathy is harder than sympathy."

"That's right," I replied. "Empathy is harder, and it's more helpful but less common; sympathy is less helpful but more common."

I told them a story of what happened to me in the hospital when I had my stroke.

"Somebody who will remain nameless sent me a sympathy card that said, 'Sorry to hear of your loss.' I felt like I had died. But I didn't. She should have sent a 'get well' or 'thinking of you' card. So sympathy cards should be carefully selected, for mainly death in the family or friendship circle. Sending a sympathy card to a stroke survivor is wrong, mainly because they survived."

I was starting to lose their attention with my story, true though it was. I went on with more detail and their pens were poised once again.

"Empathy can apply to lots more things than death, like getting caught in the rain without an umbrella when you're going to someplace important, losing lots of weight, or changing a tire on a busy highway. If you experienced any of those things, then you know what you're talking about when you say, 'I know how you feel.' And empathy can apply to good things, too."

The girl who had to get an "A" in the project to not bomb out yawned loudly. And then she yawned again. The "car" girl wasn't far behind, but she stifled the yawn out of respect for me. 

We had an appointment coming up and had to leave, and the girls stood to let us by and soon took their new seats once again.

"Thank you," the girls said in unison.

"It was my pleasure," I said. And it was. I was the professor again and I felt great. On the way out, I said, "I'm glad I had the opportunity to teach those girls."

My friend said, "I know how you feel. I'm happy for you." She was practicing empathy. And she was a professor, too.