A Nursing Home Mini-Series: Life with Old People

Some of you missed my last post -- http://stroketales.blogspot.com/2014/07/wake-up-stroke-survivors-before-its-too.html -- in which I told the outcome of my stroke-related surgery. The surgeon said the operation was successful. I say the surgeon did the best he could with what he had to work with. 

Anyway, I'm in a nursing home now, which is divided between residents (I say "lifers") or, as with me, people who go here to recuperate. I had surgery so I fall into the second batch.

The nursing home serves three complete meals a day -- breakfast at 8, lunch at 12, and dinner at 5, plus snacks, if anybody wants them, in between and after dinner. So you could spend around six hours just eating.

The nursing home is understaffed, so the aides start bringing  people down to the dining room thirty minutes before the meal started in order for all of the people to be there when the meal officially began.

The aides are responsible, too, for bringing the platters of all people who don't want to socialize. One aide said to me, "The people eat in their rooms, if they are sick or don't want to socialize with 'old' people." I took offense at that remark because I am one of them, the old people, I mean. I don't know when it happened and I don't feel old. But numbers never lie. I am 66.

I got to the nursing home just before dinner. In the wheelchair, I saw an open spot in the table for four. One of was the little, old lady named Gert. I don't know the reason for her going to the nursing home. She died three days later and Cassey took her spot. Cassey, who was a year younger than I was, was a geriatric/psychiatric nurse who had a hip replacement. She was quiet and liked observing the other two. 

Maggy was an 91-year-old, bust-ass, no-holds-barred, obese lady who actually was comfortable and secure being obese. Maggy was a diabetic who passed out until somebody in her family had the sense to gain her admittance to the hospital. Then the doctors figured out what it was, but I never knew. And I didn't ask. She came her to rest.

And the fourth was Beatrice, 89, who said platitudes all day like "Where there's a will, there's a way" or "If it's meant to be, it will happen." Beatrice had a fall and she exhibited black-and-blue marks on every inch or two of her body. She was also a sentence finisher, like if you paused and were trying to finish the sentence, she would finish the sentence for you. Most times, she was wrong in the word that she selected. And that got the hairs on Maggy's neck to stand up at full attention.

"I don't like when you fill in the blanks," Maggy screamed.

"Well, the right word fits the shoe," Beatrice said, mixing up platitudes. Sometimes, when Beatrice got tired, she said them that way.

So that was the table. I sat with them for three weeks until Cassey's hip allowed her to be discharged. Cassey sent me an email when she arrived home, happy to be with her boys (aka cats) and her comfy, overly high bed which, as her email said, she accessed with a step stool she borrowed from her sister.  

Maggy passed out again, and Beatrice was still hooked to an IV bag for dehydration. So tomorrow, I was on my own to find new people at a different table.

That's the thing about nursing homes. I didn't think I'd have time for making really good friends because there's a fast turnover rate, akin to a revolving door. But I had enough sense that I wouldn't die trying either.

Ho Hum: Life in the Hospital Is Mostly the Same, Except Sometimes....

The most famous definition of "crazy" comes down to doing the same things over and over again and expecting a different result. I think I am borderline crazy.

When I first go in the hospital, I think that I have a few days off, a vacation of sorts, but then I realize, no more than a half an hour in, that I want to be some place else other than the hospital. It's not the hospital's fault. I own this one.

Here is what happens every time: the nurses, due to liability issues (their liabilities, not mine), take vitals--that is, listen to my chest, take blood pressure with the cuff, and record my temperature--every 4 to 6 hours, especially when I first come out of surgery. Then comes the phlebotamist (some people say "vampire") to take the blood samples. The phlebotamists start at 4:30 am. 

Then I attempt to go back to sleep, but the nurse comes in again to check your vitals before she goes off shift at 7am. Then bathroom, dressing, brushing teeth, breakfast, therapy, lunch, more therapy, dinner which is served around 5pm, and I'm in bed by 7 pm. And I am exhausted.

Also, as a patient, I always look the same, no matter what mood I'm in, as shown in the photo on the left. If I'm sad, I put on a happy face. If I'm angry at the nurse, I won't show it, especially because maybe she'll leave out the pain meds and then say "whoops" when I call her on it. And nobody likes to be around a depressed person or one who is in pain or tired. So I hide those emotions more often than not. I don't like surprises so I don't acknowledge them. We already went over the mentally ill part.

So I was surprised, a day before I left the same old, same old hospital, that a break in the routine occurred. I had the lights out at 7 and was watching some television show about country singers when a gangly, middle-aged man opened the hallway door and wandered into my cluttered room. My gut said to me, "Danger, Will Robinson." My gut was the only body part who was talking to me. I didn't hear a peep out of my brain.

"Where's the bathroom?" the man said as he rifled through some clothes in my closet. The only thing I thought of is, I'd have to wash the clothes at some point--all of them. 

Then I spoke. "The bathroom is on the opposite wall," but he went straight ahead to the hospital bureau and opened a few drawers, touching personal items. I'd definitely wash that stuff, too.

The bed and bathroom were all that remained. Fortunately, he went into the bathroom, and I called the nursing station.

"A man just went into my bathroom. I don't think this is allowed because...." I didn't finish the sentence because the nurse already hung up.

Four nurses arrived in the blink of an eye and got the man out of there. I don't know if he was "finished" or not. Apparently, they didn't care.

The man turned around toward my bed. "Thank you, lady," he said.

"Did he hurt you?" one nurse remaining said. Once again, the nurse was worrying about her liability. I can't blame her. Jobs are hard to find in this economy. The nurse continued. "He just had a stroke and he didn't know what room was his."

"No, he didn't hurt me," I said, sorry that I called the nurses at all, considering that he was now a member of the infamous club.

Wake Up, Stroke Survivors, Before It's Too Late to Do Anything!

Nobody told me about tendon transfer surgery while I was in New Jersey. Or Philadelphia. Or what I read on the Internet. So what is it? 

Tendon transfer surgery may be needed on the hand and/or foot if muscle function has been lost due to a disorder of the nervous system, like stroke. 

You probably read my post called My Upcoming Surgery for Foot Drop, aka My 50/50 Gamble.(http://stroketales.blogspot.com/search?updated-min=2014-06-01T00:00:00-04:00&updated-max=2014-07-01T00:00:00-04:00&max-results=3)

Well, I had tendon transfer surgery, by Dr. Dane Wukich at the University of Pittsburgh Medical Center (UPMC), two  weeks ago. This is the first time I could write about it to all of you because of the ongoing pain that should slow down in another two or three weeks. The surgeon called it successful, but here's the detour he had to take because he encountered two problems:

The tendon, when he got to it, was atrophied, meaning that the tendon lost the power it once had. I was 5 years post-stroke. Here's a picture of what it looked like:

Also, the bone around the tendon was too thin to safely transfer it. I had osteopenia, a step before osteoporosis. 

So the surgeon cut the tendon rather than transfer it, allowing my foot to be flat. (The tendons shorten after a stroke from non-use). That's good enough for me. I still can't wiggle my toes, but it was worth it, not having drop foot any longer. It might take more than a year to discard the brace, but at least there is hope.

Again I ask, why didn't some doctor tell me about tendon transfer surgery before it was too late to do anything?

Folks, if you had a stroke or know people who had a stroke a year ago or less, investigate about tendon transfer surgery. You'll be doing yourself or them a great favor before it's too late, and before atrophy sets in.

The Day Before My Self-Elected, Drop Foot Surgery

My grandmother, on my father's side, was born in Russia, circa 1884. She escaped to Paris for 6 months to avoid the Russian pogroms, primarily aimed against the Jews, in the late 1800s. And then, when she found a ship going anywhere but Russia, she settled in Canada. If you asked my grandmother about her nationality, given that there were a few choices, she always said that she was French because she learned the language or, at least, enough to get by. 

Sarah Bernhardt

While in Paris, my grandmother saw Sarah Bernhardt, known as "The Divine Sarah" for her flamboyant roles, on the Parisian stage a few times when Grandmom was very young. That's where my father got the idea, from his mother, that as a teenager, I was the dramatic Sarah Bernhardt, as he addressed me, complete with exaggerated expressions, dramatic entrances and exits, and sullen moods. As nicknames went, it wasn't so bad.

Anyway, I outgrew the extreme behavior patterns at twenty, right on schedule, not being a teenager any longer, and my life went on. I had a stroke in 2009, and the Sarah Bernhardt-isms returned, less dramatic but still there, like this picture I posted in Facebook about my operation tomorrow:

Everybody said I was brave and/or out of my mind to have an operation that would correct my drop foot. And that got me thinking: I was brave, but was I out of my mind?

I used to be a runner, and like most runners everywhere, I dreamed of running the Marathon. The drop foot surgery, if successful, would allow me to rotate the foot and ankle, where now, my foot always hangs there, like it's lost the fight. It might take me a year or more and a tad of money for a trainer, but the Marathon is on my bucket list, and so are square and round dancing and taking lengthy strolls. So "out of my mind"? I don't think so.

I write this post the day before my surgery because, well, who knows, from one second to the next, how "it" will go? The risks of surgery are hideous; for example, reactions to the anesthesia including anaphylactic shock or rashes, infection, vomiting, dizziness, and yes, but not likely, even death. But how can I not go through with it. I may not have drop foot any longer,  and that means I could shed the brace forever within the year! 

A little more than 24 hours to go and I'll be on the operating room table, knocked out, surrounded by the surgeon, the residents, the  anesthesiologist, the nurses.  I am going into surgery calm, collected. I'll keep a diary to share with you as soon as I can.

But even now, once again, I ask myself about the surgery, "Are you out of your mind?" 

And the answer to myself doesn't surprise me because it's always the same: "I don't think so." 

The time is ticking down, seemingly fast.

How Two Legal Drugs Caused My Hemorrhagic Stroke

Pittsburgh, PA, is the magical land of good health where people embark on a journey just to be here, with Pittsburgh's reputation of new discoveries and treatments. Just today, I heard about a doctor who gave a man an artificial lung machine in a unit no bigger than a BLT sandwich.

Pittsburgh is where I found out stuff I didn't know, like my upcoming surgery on July 14 with the famed Dr. Dane Wukich, foot and ankle expert extraordinaire, to correct my drop foot, (or foot drop), where the tendons and muscles are not working enough to pull the ankle up. I want to run the Marathon--any Marathon--so I have to get my ankle working. (But that's another story for another day).

Today, I learned even more stuff. I took Coumadin, the blood thinner, from the start of my stroke over 5 years ago until now. I had loads of doctors then, and the communication between them was, at best, lousy. So I was on Coumadin until today when the well-known hematologist, Dr. Dhaval R. Mehta, who took lots of tests last month, figured out that I didn't need Coumadin anymore.

"No Coumadin?" I asked.

"No, you're done," the doc replied.

"Do I have to ween off of it?" 

"No, you're done," he said again. "Somewhere down the line, you should have been taken off Coumadin," Dr. Mehta said.

I was satisfied with Dr. Mehta's response but not with the last part. Somebody screwed up. But he had all the test results and I listened intently. But there was still a piece missing: why did I have the stroke? I was the picture of health: low cholesterol, low blood pressure, a non-smoker, no diabetes, a runner. So I put together some of my research as well.

This is my own theory. Avelox, an antibiotic, could result in clots as the side effect of that drug. I was in the hospital two weeks before I had my stroke in 2009 for an ear infection. So the ear doctor in Philadelphia put me on Avelox, and as a result, I got clots in both legs and I went to the ER because of the pain. 

The ER doctor admitted me and I was put on Lovenox, a low-molecular form of Heparin, to break up the clots. (Now here's where the story gets interesting). As a result of being on Heparin, I developed Heparin-induced thrombocytopenia (HIT), a serious side effect that may occur when one is being treated with heparin.

HIT can lead to low blood platelet counts, which I had. My platelet count went down to 18,000 and a normal platelet count is around 237,000 per mcL in men and 266,000 per mcL in women. 

HIT occurs in about 3% of people who are treated with heparin. HIT is more likely to occur with use of higher doses of heparin, but HIT can also be caused by very small heparin doses, including the amount used to flush intravenous catheters. So the very drug that was supposed to help me gave me HIT.

HIT is sometimes referred to as “heparin allergy." However, this is not correct terminology because it is not a true allergy. In most cases, the body makes antibodies to protect us from infections. The immune system in some people, for some reason the docs haven't figured out yet, makes antibodies in response to treatment with heparin. 

After the antibodies bind to the platelets, they are removed together with the platelets from the blood stream, resulting in a low platelet count.  Thus, HIT. And HIT can cause bleeding in the brain. Thus, a hemorrhagic stroke. 

Again, it's my own theory. So no more weekly blood tests, now that my taking Coumadin has ended. No more worrying about Vitamin K and cranberries, the substances that determined, in part, my Partial Thromboplastin Time (PTT) blood result. 

I celebrated by going home and having a turkey sandwich without the leafy greens (Vitamin K). Tomorrow, as the celebration continues, I will have cranberry juice. This weekend, I'm going to have some wine. Alcohol wasn't allowed with Coumadin. 

It took me over 5 years to discover that my taking Coumadin is finally over. I am satisfied with Dr. Mehta's decision. And the mystery of why I got a stroke has ended, to my way of thinking. Two legal drugs.... You never know.

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." 
------------------------------------------
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