Researchers Say LOW Cholesterol May Be Not Much Better Than HIGH Cholesterol. WTH! They Are Saying THAT Now?

Since I was a little girl and able to understand scary stuff, my mother said that her body "manufactured" too much cholesterol. Never mind the fatty foods she ate like red meat and extra buttery toast and cheesecake, her favorite dessert. She stood by her story to the end. I was scared I would inherit the same "manufactured" condition. But I was spared even though I had a hemorrhagic stroke that was from Protein S deficiency. (Don't get me started on a lousy gene pool).

My mother probably familial hypercholesterolemia, this news  brought you by US National Library of Medicine, a disorder that is passed down through families. It causes LDL (bad or think of loathsome) cholesterol level to be very high. The condition begins at birth and can cause heart attacks at an early age. My mother didn't have a heart attack, but she could have had one easily. 

Familial hypercholesterolemia is a genetic disorder. It is caused by a defect on chromosome 19. The defect makes the body unable to remove low density lipoprotein (LDL, or bad) cholesterol from the blood. This results in a high level of LDL in the blood. 

This condition makes you more likely to have narrowing of the arteries from atherosclerosis at an early age. The condition is typically passed down through families in an autosomal dominant manner (that is, inheriting a disease, condition, or trait depending on which type of chromosome was affected). 

And that's probably what she meant by manufacturing high cholesterol. So I thought to myself, I'm lucky that I escaped the high-cholesterol syndrome, and now that I am a pescatarian or, as I like to say, a vegan with fish. That got me thinking: Can your cholesterol be too low? The answer scared me more. 

In April of 2019, a study by the American Academy of Neurology said that low cholesterol was linked to a higher risk of "bleeding [hemorrhagic] stroke" in women. 

A study found out that women who have levels of LDL cholesterol 70 mg/dL or lower may be more than twice as likely to have a hemorrhagic stroke than women with LDL cholesterol levels from 100 to 130 mg/dL. 

The study also discovered that women with the lowest triglyceride levels, that is, fat found in the blood, had an increased risk of hemorrhagic stroke compared to those with the highest triglyceride levels.

"Strategies to lower cholesterol and triglyceride levels, like modifying diet or taking statins, are widely used to prevent cardiovascular disease," said Pamela Rist, ScD, study author of Brigham and Women's Hospital in Boston and a member of the American Academy of Neurology. 

"But our large study shows that in women, very low levels may also carry some risks. [I'll say]. Women already have a higher risk of stroke than men, in part because they live longer, so clearly defining ways to reduce their risk is important. Women with very low LDL cholesterol or low triglycerides should be monitored by their doctors for other stroke risk factors that can be modified, like high blood pressure and smoking, in order to reduce their risk of hemorrhagic stroke. 

"Also, additional research is needed to determine how to lower the risk of hemorrhagic stroke in women with very low LDL and low triglycerides," Rist said.

My head was spinning. Low cholesterol and low triglyceride are considered bad now? I wanted to find out more. 

The study of 27,937 women age 45 and older participated  in the Women's Health Study (supported by the National Institutes of Health) who had total cholesterol, LDL cholesterol, high density lipoprotein (HDL or good cholesterol), and triglycerides measured at the beginning of the study. Researchers reviewed tons of medical records to determine how many women had a hemorrhagic stroke.

With an average follow up at 19 years, researchers identified 137 women who had a bleeding stroke. Nine out of 1,069 women with cholesterol 70 mg/dL or lower, or 0.8 percent, had a bleeding stroke, compared to 40 out of 10,067 women with cholesterol 100 mg/dL up to 130 mg/dL, or 0.4 percent. 

Some other factors were weighed in that could affect risk of stroke, such as age, smoking status, high blood pressure and treatment with cholesterol-lowering medications, and researchers discovered that those with extremely low LDL cholesterol were 2.2 times more likely to have a bleeding stroke.

Researchers divided the women into four groups for triglyceride levels. Women in the group with the lowest levels had fasting levels 74 mg/dL or lower, or non-fasting levels of 85 mg/dL or lower. Women in the group with the highest levels had fasting levels that were higher than 156 mg/dL, or non-fasting levels that were higher than 188  mg/dl. Researchers found that 34 women of the 5,714 women with the lowest levels of triglycerides, or 0.6 percent, had a bleeding stroke, compared to 29 women of the 7,989 with the highest triglycerides, or 0.4 percent. 

The study's key limitation was that cholesterol and triglyceride levels were only measured once at the beginning of the study. In addition, menopause was evident in a large number of the women, which prevented researchers from examining whether menopause status may be the missing link between cholesterol and triglyceride levels and bleeding stroke. More study is needed.

WELCOME TO CHECK. CHANGE. CONTROL. CALCULATOR, compliments of the American Heart association (AHA). 

https://ccccalculator.ccctracker.com/

Through blood tests, CBC and Lipid Panel, and vitals like blood pressure, you can fill in the blanks on the form to see if you're susceptible to a heart attack or stroke. Shouldn't you know rather than guess?

Statins are effective at lowering cholesterol and protecting against a heart attack and stroke, although they may lead to side effects for some people.

The Mayo Clinic says that doctors "often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke." But they have been associated with the onslaught of muscle pain, digestive problems, and mental confusion in some people who take them and may cause liver damage, albeit rare.

Statins include: 

• atorvastatin (Lipitor)
• fluvastatin (Lescol XL)
• lovastatin (Altoprev)
• pitavastatin (Livalo)
• pravastatin (Pravachol)
• rosuvastatin (Crestor, Ezallor)
• simvastatin (Zocor, FloLipid)

The reason that doctors prescribe statins is that they block a substance your liver needs to make cholesterol, and causes your liver to remove cholesterol from your blood.

If you're already on statins, talk to your doctor before stopping them. My doctor told me to stop reading articles on the Internet. Hoo, boy. Like that's gonna happen. 

If you have muscle pain, the statin you're on may be producing  rhabdomyolysis which can cause severe pain, liver damage, kidney failure, and death. The risk is very low, and numbers are equal to a few cases per million people taking statins. Rhabdomyolysis can happen when you take statins in combination with certain drugs so ask your pharmacist.

Or statin use could cause an increase in liver inflammation. But if the increase is severe, you may need to try a different statin because all statins are not alike. Again, talk to your doctor, if you also have unusual and increased fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.

It also possible your blood sugar level may increase when you take a statin, which may lead to developing type 2 diabetes. 

The risk is barely significant but important enough that the Food and Drug Administration (FDA) has issued a change on warning labels regarding blood glucose levels and diabetes with statin use prevalent.

Also, the FDA issues a warning on statin labels that some people have memory loss or confusion while using statins.

Everyone who takes a statin may not experience side effects. 

Risk factors include:

• Being female
• Being age 80 or older
• Having kidney or liver disease
• Drinking too much alcohol
• Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS)
• Having a small body frame
• Taking multiple medications to lower your cholesterol

If your doctor says it's fine, take a small break from statin and see whether the muscle aches or other problems you're having are statin side effects. It may be just part of the aging process.

Or switch to another statin drug if that's ok with your doctor. 

Or change your dose with the doctor's permission. Another option is to take the medication every other day, especially if you take a statin that stays in the blood for several days. Again, talk to your doctor.

More than usual exercise may increase the risk of muscle injury. And it's difficult to know if your muscle pain comes exercise or a statin. 

One more thing. Is your diet healthy enough not to produce high cholesterol and, by the way, high triglycerides? My mother, again, probably had Familial hypercholesterolemia, the inherited gene that you could help by eating healthy, exercising, and not smoking, all of which my mother did not do. No wonder it's taking researchers so long to relate strokes to the countless number of variations in lifestyles. 

Life's Lessons: I Ain't as Good as I'm Gonna Get, But I'm Better Than I Used to Be

I admit it. This refrain was borrowed and comes from Tim McGraw's country song, Better Than I Used To Be, the song that asserts he could finally stand the man in the mirror that he sees. I love that song and realize that now, almost 11 years post stroke, that song could have been written about mostly me. I turned the negatives that were mentioned in the song around to positive ones. 

Please listen:

https://www.youtube.com/watch?v=WO0keYA21oI&list=RDWO0keYA21oI&index=1

He sings:

Hold a grudge

I used to hold grudges--like, forever. But no more. For example, there was my his-way-or-the-highway sibling and his super-controlling wife. I realized, or pretended to imagine, that they liked to have power, but I wasn't going to be a party to that. Or my colleagues that didn't listen to my demands for speaking without confrontation. Or my neighbors who didn't throw the mouse in the rubbish when it came to land in our shared driveway with my two kids playing. Having no grudges means I'm free of all that negativity and that the cliche Life Is Too Short really means something. You must let...it...go! 

The hearts I've broke

Yes, I broke some hearts because, and as my sons say, I liked men with edge because of my sheltered past, not nice guys who would gamble and fight rather than the nice ones who would have been perfect husbands and fathers. I was married to an edgy guy for 18 years who threw food on the floor if he didn't like it, broke furniture in a fit of rage, once inches away from my infant son, and threatened me countless times. The other person was simply a mistake that lasted 16 years when I should have known better. There were signs, yes. But they're both now dead to me, the first literally, the other figuratively. I found a couple of nice ones I'm sort of interested in, but time will tell if those feelings are returned. And I'll be smarter this time around.

People I let down

Sure, I let people down, and I had reasons, albeit faulty and selfish, to do so. But show me people who don't have any regrets in their whole lives, and I'll show you liars. From not agreeing with contentious friends to not cooking what I said I was going to bring to a pot luck supper, I let people down, so down that they stopped speaking with me. But, come on! Over politics or Shepherd's Pie? I enjoy the present now, not dwell upon the past or have apprehension about the future.

There's some dirt on me

Absolutely, there's some but not a whole lot, like the time I used my friend's mascara when I had an eye infection on Saturday and then two days later on Monday she found out after she used that mascara on Sunday the day before (ouch! that was really a bad one) or how about the time I applied for the same position as my colleague, and  gossiped to people I knew would spill the beans about her secret drug addiction,  and she didn't get the job. I did. As Oscar Wilde once said, "Experience is simply the name we give our mistakes."

But I have one thing that wasn't in the song. Patience! Do you know how I got patience where there wasn't any before? From my stroke. Talk about a silver lining! It took a while to develop it, but now patience is with me all the time. People write to me occasionally to ask how I developed patience instead of constant anger and frustration. I practiced becoming patient because, in truth, it doesn't come naturally, at least to me. You have to want it, and it will come, not right away but eventually.

Maybe, in time, I'll become like that character from the television show My Name is Earl, a f-up who won $100,000 in the lottery and decided to correct all the wrongs from his past. Or maybe, and most likely, I'll begin again in "it's-never-too-late" fashion  to make the right decisions this time around. Whichever I choose, I, too, could finally stand the woman in the mirror that I see.

Kobe Bryant and Me: Thoughts on Life and Death

I never knew Kobe Bryant even though we each lived in Pennsylvania at some point in our lives, less than 30 minutes and years apart --me for 60 years and Kobe for 18 years when, upon graduation, he went to his only team, the Los Angeles Lakers where he had a 20-year career. He was scouted as #1 in the country and played in the National Basketball Association (NBA). Among his many accomplishments, as a shooting guard, he won five NBA championships, was an 18-time All-Star, and got to be the best shooter ever after Wilt Chamberlain.

Unless you've been sequestered with jury duty or living under a rock, Kobe died Sunday along with his daughter and 7 others in a foggy and then fiery helicopter crash which killed them all. 

I watched the news reports Sunday and, after a while, stopped watching because the reporters occasionally brought up that incident where in 2003, Bryant was accused of sexual assault by a 19-year-old hotel employee. Shortly after, Bryant issued a public apology, with his wife by his side, but that action resulted in several endorsements which were cut off immediately including McDonalds and Nutella.

Then the devil sat on one shoulder and said, "Was that really necessary to bring that up considering all the good things he did, like the Kobe and Vanessa Bryant Family Foundation whose goals were helping young people in need of support, encouraging the development of physical, emotional, and social skills through sports, and assisting the homeless? Didn't the good things eventually overpower the bad? Can't we just move on?" 

But the angel who sat on the opposite shoulder said, "Can you really get over sexual assault?" The angel won.

It was 1 in the morning now on Monday. But I was really into it--the thinking, I mean. I sat on my comfortable sofa, for 3 hours, just hammering out what had happened. The Grammys were on Sunday as well in the Staples Center where the Lakers played. I started feeling overwhelmed.

I said to myself, if Kobe was so famous, and people tend to forget even the famous over time, little by little, what chance do I, a regular person, have to be remembered? I fell asleep somewhere in the middle but didn't lose direction one bit, returning to the internal discussion at hand.

Then around 2 on Monday, I thought of my father who was killed in his North Philadelphia store in 1971, and I didn't even think of him every day after awhile, except right around the holidays which were important to him because, other than working seven days a week to support his family, he liked fun. 

It was about 3:30 on Monday. The only thing was the country by Randy Travis called Three Wooden Crosses that pulled me out of whatever had taken over my mind. The song is  about four people--a farmer, a teacher, a preacher, and a hooker--going down to Mexico in search of various things. He was awarded the Academy of Country Music Award for Song of the Year. Listen to it for a moment.

https://www.youtube.com/watch?v=LT1sNrgnJZc

It's the refrain. 

I guess it’s not what you take when the you leave this world behind you.

It’s what you leave behind you when you go. 

And then I also knew. My father left his incredible work ethic, Kobe left his iconic basketball fame, and I guess people will remember me, too, albeit I don't know for what. 

I asked one of my sons the next day, "Will you miss me when I'm gone?"

He took a long time to answer and then he said, "You have your moments."

That's good enough for me, wiseass.

Knock, knock! I Was At Death's Door. And Then I Wasn't, aka The Issue of Turning Off the Life Support Machine Too Early

When I had my hemorrhagic stroke in 2009, my boys knew I had a zest for life from the way I lived it up to that point. I didn't have it written anywhere, but they just knew that I wouldn't want to die then at 60. Having put me in a medically-induced coma with a feeding tube and more wires that seemed to me, at the time, of going nowhere and everywhere, the doctors held little hope that I'd survive at all, and they thought surgery would finish me off completely, and only blood thinners would sustain me, if at all, in the life I now have.  

Reported by The Daily Telegraph, a London newspaper, in 2013, an American study suggested that one third of patients who suffer a specific form of stroke are having their life support machines switched off when they might recover.

The study from the University of Washington Stroke Centre in Seattle looked at two groups of patients who had suffered brain bleeds. They matched 78 patients whose life support was turned off to 78 patients that still had the machines on.

The researchers found that 38% of those who life support machines were utilized after some reasonable time period made a reasonable recovery, and kept progressing. (About 10% of strokes annually are intracerebral hemorrhages (ICH), that is, brain bleeds). But only 4% of those whose life support machines were turned off made this comparable and early level of recovery, despite the fact that the two groups were compared evenly on stroke severity.

Dr. David Tirschwell, the main author of the study and co-director of the Stroke Centre, said, "Greater patience and less pessimism may be called for in making these life-and-death decisions. These results are yet another piece of evidence suggesting healthcare providers may be overly pessimistic in their assessments of these patients' prognoses, leading families to choose withdrawal of life support before the patient has had a chance to recover from their stroke."

Professor Steven Greenberg, chairman of the International Stroke Conference, and professor of neurology at Harvard Medical School, said, "The finding that fully a third of ICH patients in whom life support is withdrawn might otherwise survive is staggering."

A more recent study in 2019 entitled A Fate Worse Than Death: Prognostication of Devastating Brain Injury, by Pratt et al says, 

"[Doctors] should consider the modern literature describing prognosis for devastating brain injury and provide appropriate time for patient recovery and for discussions with the patient's surrogates. Surrogates wish to have a prognosis enumerated even when uncertainty exists. Respect for patient autonomy remains paramount."

Also in 2019, reported by Dr. Robert Truog, is when someone encounters a traumatic brain injury [and stroke is one of them] and is unresponsive, how soon can doctors say if the person has a reasonable chance of recovery? New and stricter guidelines from the American Academy of Neurology prompts making the choice more difficult.

Truog writes that the practice now in most ICUs is to help families make a decision about whether to stop life support within the first 3 to 5 days after the injury. After 72 hours of observation, the physicians are likely confident in predicting a poor outcome as “extensively supported in the literature.” But is that enough time? 

Take me, for example. On life support, my medically-induced coma lasted over a week. And the doctor still wasn't confident of any projected outcomes close to a month later in the ICU. My sons would have been devastated if the doctor recommended stopping life support. I owe my thanks to my sons to counter any thoughts of stopping the machine. And to the doctor, of course, for listening to them.

Brain injury survivors or not, do it now! If you have any future brain injury, write down that you want to live, to enjoy all life has to offer you, for as long as you can. Write it down now to not rush the termination process, and put it on the refrigerator with a magnet. Or place it somewhere else that even a terrible searcher can find it. 

Three to five days is nowhere enough to predict outcomes. I am living proof. 

As Marcus Tullius Cicero, a contemporary of Caesar, said, "While there's life, there's hope." 

Amen to that, brother. 

Brain Fog: We All Get It Sooner or Later, But With Brain Injury, It's REALLY Noticeable

Some of my best friends call it a "senior moment" when they forget, let's say, the name of an actor or a specific date. Some others say it's a "brain fart" when we lose the thread of a conversation. But more commonly, you zone out more often when you have a brain injury. And a stroke is one type of a brain injury in addition to other kinds of brain injuries, like a concussion or auto accidents or assault. 

So welcome to the world of brain fog.

Let me say fatigue is different from brain fog. With fatigue, you "need," rather than "want," a nap. You lie down in the afternoon for a couple of hours and wake up feeling sort of refreshed. Until you're standing, you might wake up and feel that something interrupted your nap--the alarm, in my case. (I set the alarm if I feel fatigued just so I don't sleep too much that will interfere with sleeping at night. I've discovered that two hours before 1pm won't disrupt nighttime sleep. It's trial and error for you until you get it right). 

But brain fog differs. Though it may have overlapping symptoms with fatigue, it's more than just feeling tired. It’s when fuzzy thinking or the inability to feel sharp are present. You feel that you're not yourself in that moment, and slow thinking, confusion, difficulty focusing, forgetfulness, or a haziness are also part of brain fog.

The top five things to do, if you have ruled out medications or other conditions that bring on brain fog, is to examine the following in your life:

SLEEP

The Center Disease Control (and recently added Prevention) says more than 35 percent of US adults are getting insufficient sleep which the CDC defines as less than 7 hours. The sad part is almost 12 percent of Americans are getting less than five hours a night. If you lie down and take a short nap, even a 15-minute power nap, you probably won't compromise your sleeping at night. That's what I do. Here's what the rest of the country's doing, sleep-wise.  

And here's something else that will guide you, coming from the National Sleep Foundation:

• Newborns (0 – 3 months):  14 – 17 hours (with naps)
• Infants (4 – 11 months):  12 – 15 hours (with naps)
• Toddlers (1 – 2 years):  11 – 14 hours (with naps)
• Preschoolers (3 – 5 years):  10 – 13 hours (with naps)
• School-age (6 – 13 years):  9 – 11 hours
• Teenagers (14 – 18 years):  8 – 10 hours
• Young adults (18 – 25 years):  7 – 9 hours
• Adults (26 – 64 years):  7 – 9 hours
• Older adults (65+ years):  7 – 8 hour

CHANGE YOUR DIET TO INCLUDE BRAIN-BOOSTING FOODS

I'm almost vegan now although my son tells me you're either vegan or you're not. He says this because I eat fish, too. Pescatarian works, too, meaning vegetarians who eat fish as well.

Anyway, I've gone plant-based, meaning nothing that has a pulse--plus fish which does. (I can see my son rolling his eyes as he reads this post). My standard diet consists of broccoli, any kind of fruit, quinoa, nuts, and fish. For more information, write to me--hcwriter@gmail.com and I'll give you my complete diet. I feel better now, with brain fog occurring very rarely, twice a year at most!

DE-STRESS YOUR LIFE 

Harvard Medical School says, "Simple things, like a warm bath, listening to music, or spending time on a favorite hobby, can give you a much-needed break from the stressors in your life."

The Chopra Center says, "Recognizing the triggers to your stressful reactions is an important first step in managing your stress. True, it might be impossible to remove life’s stresses, but understanding the things that stress you out—and in what ways—is particularly helpful in solving the underlying problems." 

With brain injury, it's not too difficult to assess. It comes with the territory. So what do I do? Listen to country videos really loud via a headset. Or take a hot shower. Aah.

TUNE OUT WITH A MINDLESS ACTIVITY

If you don't know what qualifies for a mindless activity, you can spend $6 and buy this book on Amazon. Mazes and coloring books and gardening are included. But you have to be a Prime member. If not, the book will cost you more.

The other option is free. Putting away dishes from the dishwashers, folding the laundry, playing a video game, practicing tying my shoelaces one-handed, or reorganizing all the overflowing stuff on my desk that I do is all mindless. No charge for borrowing from my list!

As Odelya Gertel Kraybill, Ph.D., says in Psychology Today, "Survivors need to reconnect to spontaneity since it’s essential to the experience of  joy.  A powerful strategy for this is what I call intentional mindlessness. When we engage in mindless action, whether playing sport or other games, dancing, drawing, hiking, singing or playing music, or any other activity that absorbs us in a fun and playful way, our spontaneity increases."

EXERCISE

The Mayo Clinic offers this list and sums up all the good elements about exercise:

• It pumps up your endorphins, the brain's feel-good neurotransmitters.
• It's meditation in motion. You'll often find that you've forgotten the day's irritations and concentrated only on your body's movements.
• It improves your mood. Regular exercise can increase self-confidence, it can relax you, and it can lower the symptoms associated with mild depression and anxiety [leading to brain fog]. Exercise can also improve your sleep.

The Mayo Clinic also reminds us that :

• Do what you love. Virtually any form of exercise or movement can increase your fitness level while decreasing your stress. The most important thing is to pick an activity that you enjoy. Examples include walking, stair climbing, bicycling [I have a recumbant bike, thanks to my kids], yoga [there is armchair yoga, too, where you sit down while performing yoga], gardening, and swimming.
• Pencil it in. Carving out some time to move every day helps you make your exercise program an ongoing priority.

So there you have it--five way to lessen brain fog, or eradicate it altogether. But you can't pick and choose. Try all five for a month. What do you have to lose? Yeah. Nothing.

My List of Bitchin' Resolutions for 2020: Oh, Yeah, Oh, Yeah!

Among the mayhem of impeachment and blame and Medicare for all and abolishing student debt and climate change and the Green New Deal, and lots more including my life as a stroke survivor which has lots of mayhem, there is one constant: New Year resolutions, the promises you make to yourself that by the end of 2020, you will do all on the list. Promises made to yourself, at least in my point of view, shouldn't be broken. 

So here is my list, and I will try to accomplish them all.

1.  I vow to do something now in 2020--a favor, for example--without expecting something in return. The opposite is, I'll do this in exchange for you doing that. That's called quid pro quo. You might have seen it on the recent news shows in regard to President Trump where he said he'll give Ukraine the money in exchange for digging up some juicy dirt on his opponent. I'd venture to take a guess that all presidents are guilty of quid pro quo at least once in their tenure. But I digress.

2.  I see a notable difference with how I was post stroke 10 years ago and now. If I wait in the doctor's office too long, I'm ok with it. If I wait in the bank line too long, I'm ok with it. If the restaurant takes a table for two ahead of me, I'm ok with it. So I want to continue being patient until, well, you know.

3.  It took me 6 months to join a band, and then I did as a keyboard player. I'm the only one who plays keyboard so it turned out that I was a welcome addition. But I promise myself to join other things, like political groups and meet-ups!

 

4.  I'm going to make a concerted effort to save more money this year. I went over the budget for entertainment and food, areas that I can control, and there's definitely room to cut corners. It's a question of wants and needs. I'm going to the latter increasingly more often.

5.  As a stroke survivor, there are limitations on exactly what I can do. I can't do any floor exercises for the simple fact that I can't stand up after I do them. But I can do my stationary recumbent bicycle and take walks, albeit slowly. Anything that gets the muscles moving, according to Katie, my Physical Therapist. So as a result, I am losing weight. Recently in the last 6 months, I am a vegetarian now (in fact, practically vegan but I eat fish every other day to keep up my protein level which took a dive) so I plan to lose more weight instead of extra baggage.

6.  My iPhone 6 needs a portable charger now to operate. Even though I won't get an upgrade until it dies, I use it too much. I vow to use it less and wait until I'm home to not research things like what does Matthew McConaughey's wife look like or how many calories are in kale when I don't have any intention of eating it or when did Princess Diana die. These are all "I can wait" questions.

 7.  I'm writing my third book, a fiction, which is out of my comfort zone. But that's the reason I'm doing it. I like a challenge. I get to it less than I'd like, busying myself with a movie or another book in my growing collection, but in 2020, I'm going to finish it.

8.  Once in a while, while I'm in the wheelchair, and go to the store or a doctor's office, if I ask a question, the person talks to my assistant rather than cast her eyes lower and talk to me. Call it a pet peeve, but when anybody does that, I'll interrupt and say, "Talk to me. I'm sitting right here." At first, they're startled, and look at me as if I have two heads, but when I explain the perils of being lower than everybody else, they get it. I'm still doing it, 10 years post stroke because I do it for me and all the other wheelchair-bound people, to educate them, one person at a time. I've written about the invisibility of it all several times in my blog, The Tales of a Stroke Patient and More. I vow it won't stop.

9.  I promise I won't "sleep in" anymore. My schedule Monday to Friday is I have an assistant who is fabulous, and helps with the chores and acts as a driver if need to go to the store, for example, and comes at 10. I move slower now and prepare myself for the day at 7:30. But my Circadian Rhythms get disrupted on the weekends from "sleeping in." So my goal in 2020 is that I'll get ready for the day no matter which day it is. 

10. Before you can love others, you have to love yourself. And I made it. Finally, I'm there! I'm not perfect--nobody is--but I know I'll keep working on the flaws I have. Digression, poor-timed spontaneity, and bad decisions are inching closer behind me.  

So Merry Christmas or a joyous Hanukah and Happy New Year. That's all for 2019, and may you find peace and happiness in the year ahead. And keep reading! Plans to stop writing the blog? Heh, heh. Not even on a bad day. My first blog in the new year is all about brain fog. Stay tuned!

Stroke and Gut: There's a Connection, aka I Had a Stroke Before They Really Knew

I have a sensitive stomach, and ever since my stroke, more sensitive, which I didn't think was possible. With the holiday season upon us, I wanted to know WHY! In other words, is there a connection between stroke and gut?

Harvard researchers found stomach problems could be linked to after-stroke stress. In fact, the gastrointestinal (GI) tract is sensitive to anxiety, anger, depression, and sadness, too (all of which I've had post-stroke), and it can trigger symptoms in the gut. Therefore, the brain reflects what the GI system feels. Stress is the worst, the researchers concluded. (Fun fact: I used to consider giving a stressful TED talk about stroke; I'm not anymore). 

In an article called "A Hidden Factor in Stroke Severity: The Microbes in Your Gut" by Jordana Cepelewicz, she talks about a new study in mice which demonstrates that manipulating the microbiome [the genetic material of all the microbes - bacteria, fungi, protozoa and viruses - that live on and inside the human body] can influence the extent of brain damage caused by a stroke. 

A study involving mice, published this week in Nature Medicine, argues that striking the correct microbial balance could prompt changes in the immune system that would be likely to reduce brain damage after a stroke.

Researchers at Weill Cornell Medical College and Memorial Sloan Kettering Cancer Center wanted to find out whether they could shift the balance of these cells to favor beneficial cells by meddling with the mouse bacteria. 

So one group’s intestinal makeup was resistant to antibiotics and the other group bacteria was susceptible to treatment. When the latter group was given a combination of antibiotics over the course of two weeks, the microbes underwent change. Then the researchers obstructed the cerebral arteries, inducing an ischemic stroke [the most common type of stroke]. They discovered that the resultant brain damage was 60 percent smaller in the drug-susceptible mice.

Finally and painstakingly, the researchers took the colons of mice that had ischemic stroke and transplanted to new mice with no antibiotics, thus establishing a group with finagled gut bacteria but no drug exposure, and discovering that these mice had also acquired protection against stroke. 

“These cells determine what kind of inflammatory immune response the brain is going to experience after stroke,” says neurologist Constantino Iadecola, director of the Brain and Mind Research Institute at Weill Cornell and one of the study’s authors. “Immune cells end up helping out instead of contributing to the damage that occurs."

A mouse’s genetic material is quite different from that of a human, and researchers will need clinical data, but at least they're trying.

"This is just the beginning,” says Ulrich Dirnagl, a neurologist at the Center for Stroke Research Berlin who read the results. “The study links the microbiota and the immune system and the brain in stroke—an acute brain disorder—in one story. That’s really novel." 

That it is, Dr. Dirnagl. That it is.

From the Journal of Digestive Diseases Foundation, a study was done to emphasize the GI problems that happen with stroke survivors which is directly associated with their quality of life. 

Stroke patients were evaluated for common gastrointestinal symptoms including type and site of stroke admitted over an 18-month period with symptoms of vomiting, dysphagia (difficulty swallowing), constipation, masticatory difficulties (including the muscles of the lips and tongue and the vascular and nervous systems supplying these tissues), and sialorrhea (drooling or excessive salivation), among others. 

There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischemic stroke. 

The American Academy of Neurology says that people who have GI bleeding after stroke are more likely to die or become severely disabled than stroke survivors with no GI bleeding.

“This is an important finding since there are effective medications to reduce gastric acid that can lead to upper gastrointestinal bleeding,” said study author Martin O’Donnell, MB, of McMaster University in Hamilton, Ontario. “More research will be needed to determine whether this is a viable strategy to improve outcomes after stroke in high-risk patients.”

The study focused on 6,853 people who had ischemic strokes, and of those, 829 people died during their hospital stay and 1,374 died within six months after the stroke.

A total of 100 people had gastrointestinal bleeding while they were in the hospital. In more than half of the cases, the GI bleeding occurred in people who had less severe strokes. Of those with GI bleeding, 46 percent had died within six months, compared to 20 percent of those without GI bleeding. 

The study was supported by the Canadian Stroke Network, the Ontario Ministry of Health and Long-term Care, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences, and the University Health Network Women’s Health Program in Toronto.

Patients with ischemic or hemorrhagic stroke are at risk for systemic complications, says the National Institutes of Health. No study to date has addressed causes of gastrointestinal hemorrhage in stroke, but the researchers intuitively assign the bleeding to stress ulcers. The study focused on 17 patients with gastrointestinal bleeding after stroke which is rarely severe and may not contribute significantly to mortality. 

Hmm. So the two latter studies contradict each other on mortality, but studies are like that: if you want to prove a point, do a study. But one thing is for sure: GI bleeding, or any other bleeding, for that matter, is not good. And when you have a stroke, it's really not good. 

In my mind, I wonder whether for the ones that died abused their bodies through excessive alcohol use or they ate cholesterol-rich fast food pre-stroke or it was a case of hospital errors. Who knows. Neither of the studies addressed that issue. Whatever the case, if you're a sufferer of GI bleeding, depending on the origin of the bleed, and if there's no other option, surgical intervention may be appropriate.

I'm reminded of the famous quote:

Into each life some rain must fall. 

Henry Wadsworth Longfellow

And this is my quote:

Sometimes, life is a torrential downpour. With a stroke, life becomes a never-ending tsunami.