Do You Think Stress Alone Can Cause a Stroke?

My stroke was inherited, a Protein S deficiency which causes blood clots. And you probably know the rest and the reason this blog came about.

I've been quite stressed lately because I've been inside, no thanks to the pandemic, and I thought, bordering on overthinking, would stress give a person a stroke? Or a second stroke? 

Most people already understand that high blood pressure, high cholesterol, and smoking increase a person’s risk of stroke. But without those negative situations, can plain old stress cause a stroke? Unfortunately, studies have shown so, all around the world. Just a sampling....

The Copenhagen City Heart Study, who asked people about their stress levels and analyzed their health, concludes, “Self-reported high-stress intensity and weekly stress were associated with a higher risk of fatal stroke compared with no stress.”

Researcher Ana Maria Garcia, MD, of the Hospital Clinico Universitario San Carlos in Madrid, says, “Our findings indicate that people can lower their stroke risk by attempting to reduce the stress in their lives. The study included 150 people who'd had strokes and 300 randomly selected people who had not had strokes. The average age of the participants was 54, which is much younger than the typical stroke patient."

Garcia says that studying the correlation of stress on stroke was easier in younger people who had strokes because they were less likely to have health issues like high blood pressure that have been linked to stroke.

 

The American Academy of Neurology  says that anger and other negative emotions may be triggers for ischemic stroke. The study found that people who had strokes were more likely to have experienced anger or negative emotions in the two hours prior to the stroke than at the same time the day before the stroke. They were also more certain to have reacted fast to a surprising event, such as arising at night  suddenly after hearing a child tumble and cry or standing up from a chair in haste after witnessing a tumultuous noise.

Stress causes the brain to release certain substances that adapt the body to confront a risk. They are known as chemicals: cortisol which prompts the body to retain water, salt, and sugar to help keep blood pressure on the up side and, in most cases, allows the body has extra power to function, and epinephrine which increases heart rate and blood pressure to distribute blood to the organs.

Flint Rehab says, "Persistent high cortisol levels increase salt retention, which leads to hypertension (high blood pressure) and high cholesterol levels. High cholesterol and blood pressure in turn both increase your risk of stroke.  In addition, high blood pressure from chronic stress can increase the risk of a hemorrhagic stroke, which occurs when blood vessels rupture."

It's the chronic stress, not once-in-a-while stress, that can cause a stroke. Here is a list of many signs that you're in a stressful situation:

• Chest pain
• Sudden headaches
• Low energy
• Stomach problems such as diarrhea
• Tense muscles
• Shaking and/or cold sweaty hands
• Insomnia
• Dry mouth and difficulty swallowing

Stress can also cause emotional and cognitive issues such as the onslaught of frustration regularly  or constant memory loss. Since there is a strong tie between stress and stroke, it’s important to find ways to incorporate lifestyle changes such as eating a healthy diet, doing meaningful exercises, and practicing meditation. 

But all that said, lousy inherited genes like I have? Unfortunately, there's no help for that. BAM!!! Just like so.

Physical Therapist: Push. Pull. Lift. Lower. Me: I'm 72, For Cryin' Out Loud!

Countless times on the therapy table

I am always with pain in my affected stroke-induced leg, that sometimes gets unnoticed if I engage in an activity that I love, like watching Poldark again (which I have seen more times than I'll admit) or writing my blog (which I am doing now). I often wonder, when is it time to stop physical therapy (PT) altogether. 

To be truthful, I have had many falls since the stroke almost 12 years ago. That's when I stopped going to the PT, multiple times, and lie on the sofa to rest whatever part was injured, and when I'd recover, I was back a few paces from where I'd been. To keep myself from falling, I eventually got a transport chair that keeps me safer. I can still walk with a cane, but I scoot around at home. 

It stands to reason that I would never get rid of the pain, that mild tingling, annoying sensation that sometimes goes into spasmodic reverie every 18 seconds (I know because I counted), but at 72 years of age, what do I need physical therapy for anyway, arguing with myself, hoping that I'm wrong. 

All physical therapists have had the patients who miss a couple of sessions, don’t listen to the recovery suggestions, or completely quit. Though physical therapy exercises are important for recovery, they can be tough to accomplish.

Steven Marano, PT and Facility Manager at Midwest Orthopedics in the Chicago-based Rush University Medical Center, estimates that most physicians or physiatrists will offer a four to six week prescription for PT, and for post-operative patients, between 12-16 weeks.

“Some of it is just patient expectation,” says Marano. “A lot of the time, people are unaware of how muscles are built, how mobility is increased, and how flexibility is increased. And I think it’s important on the first day to give them timelines for how long it’s going to take.”

But patients have lives outside of PT, and that can often get in the way, even for highly motivated patients. And the cost puts some patients in a dilemma likening to "the pain will go away if I want it to," often delusional thinking. 

You might be increasing your reps and sets too quickly to prompt relapse and going backwards to the gains you've made. Therapists that I've interviewed think this is the number one reason people stop physical therapy suddenly. 

Dennis Treubig, PT, DPT, refers to the Pareto Principle, or the 80/20 rule.

"In case you are not familiar with this principle, it states that, for most events, approximately 80% of the effects come from 20% of the causes.  I believe this is applicable to rehab exercises – 80% of our results probably come from 20% of the exercises we give to patients (or should come from 20% of the exercises).  This means that if you focus on the appropriate 3-4 exercises and cut out the rest, you will get similar results.  And, I believe, better satisfaction from your patients." 

Excellent thought, Dennis! More and more exercises may not be better.

If I make an increase in repetitions or sets of exercises, I increase by one time meaning, if I have been doing that exercises 5 times, when I increase it, I do it for 6 times. I keep a log and average increasing reps about once every two weeks, and if it's too much, I revert to the original right before the increase. 

I refer to it as the bad pain and the good pain, distinguished only by my heading for the sofa to rest, breathless and just getting there [bad pain] opposed to a feeling that I've accomplished something and can still scoot or walk [good pain]. There's a very fine line between the two, of course. But listen to your body. It'll know.

So my conclusion? I'll take physical therapy as long as the doctor says it's beneficial, and even then, I'll get a second opinion if otherwise. My current PT says, "Keep the muscles moving." 

I agree. The only way I'd stop is if the final curtain comes down. Get my drift?