The Silent Stroke: Holy Crap! aka You Might Have a Stroke and Not Know It Until Something's Not Right in Your Brain

My hemorrhagic stroke (there are two prominent ones: hemorrhagic and ischemic) was evident: facial paralysis (especially the eye slightly closing and the crooked lip), one-sided weakness (little movement or none al all), and trouble talking at first (I didn't speak for 5 weeks). But not everyone experiences those symptoms. Welcome to the Silent Stroke. 

I started falling a lot, thinking it was just clumsiness, or wearing shoes to go to the law firm that were fashionable, albeit ill-fitting. Don't do what I did--have yourself checked out.

Wed MD says some people have a stroke--the Silent Stroke--without comprehending it, without easy-to-recognize symptoms, but they do cause permanent damage in your brain.

Insist on an MRI or CTscan because brain scans are seen through those machines, especially if they're giving you very subtle clues, like slight memory problems or a little difficulty getting around.

A study of middle-aged people with no apparent signs of stroke found that about 10% had brain damage from silent strokes.

Yes, the damage that happens is permanent, but therapy might help revive other parts of the brain so you regain abilities. 

Heidi Moawad, MD, a neurologist, author, and editorial board member of Neurology: Clinical Practice, says, "A stroke is such a significant event that it is hard to believe that some strokes actually go completely unnoticed. In fact, many patients can be completely caught off guard and are shocked to learn that they have been living with an 'old stroke' that did not cause any handicap at all, which is referred to as a 'silent stroke."

Being told that you have had a previous silent stroke certainly may sound like shocking news, but it is not cause for alarm. If you have had a silent stroke, that simply means that it is time for a new strategy for taking care of your health.

As with most things, there is good and bad news about silent strokes. 

The good news is that silent strokes are generally easily ignored. Also, they are silent because they take place  in regions of the brain that control functions that are also powered by other areas of the brain. So this means duplicate brainpower which allows some strokes to happen without any consequences. Studies have shown that people who are mentally and physically fit essentially have 'spare brain power' with fewer or no symptoms or handicaps at all.

The bad news is having had a silent stroke indicates that you have or have had one or more of the risk factors of stroke,  including cerebrovascular disease, heart disease, diabetes, high cholesterol and/or blood pressure, a blood clotting disorder, drug use, and/or smoking. Also, you might begin to experience neurological symptoms if you have another stroke in the future if you had silent strokes in the past. Several small strokes can suddenly cause serious symptoms, such as vascular Parkinson's or vascular Dementia, often due to the effect of damage to multiple areas of the brain cumulatively, even if they are small areas.

A mini stroke describes a transient ischemic attack (TIA). A TIA is a stroke that causes noticeable symptoms that reverse and all always improve without any permanent brain damage. It is a warning, but it does not appear on a Brain MRI or Brain CT scan. Not so with a Silent Stroke, which causes permanent brain damage. 

From the blog of parkridge health system, "every 40 seconds, someone in the US has a stroke, according to the Centers for Disease Control and Prevention. Every four minutes, someone dies from one. But there's a related condition that's even more common, which gets little attention: Silent Stroke. Some experts estimate that for every stroke that causes symptoms, there are about 10 silent strokes in the US."

Parkridge define a stroke as "a sudden onset of neurologic impairment following a vascular insult. 'Vascular insult' means a vessel in your brain is bleeding or being blocked by a clot or sticky plaque buildup. Both bleeds and blockages can damage or destroy healthy brain tissue, causing serious neurological symptoms."

Silent strokes are caused by brain bleeds or blockages also, but they tend to take place in a part of the brain called the white matter and produce subtle effects like memory and reasoning losses. 

Parkridge goes onto say that we should be concerned about silent strokes because they can have "subtle, long-term effects that could interfere with your daily life and independence. Over time, people who have had a silent stroke may notice difficulties with reasoning, gait changes, mild-to-moderate memory loss, and psychiatric disorders like depression.

This statement is from Harvard Medical School: there is also another type of stroke—one that is harder to determine. 

"Termed a silent stroke, it creates areas of damage in the
brain. These areas of dead brain cells are smaller than with a
traditional stroke and they impact less-functional areas of the brain, but researchers are finding that they can still have a significant and lasting impact on memory. Researchers estimate that more than one-third of people over age 70 have had a silent stroke. For people of all ages, every person who has a stroke with symptoms, there are about 14 others have a silent stroke."

A silent stroke, as seen on an MRI, involves small spots of damage to areas of the brain that are not directly associated with functions such as vision or speech. Researchers, however, are finding these silent strokes can have an impact on memory.

During a silent stroke, blood flow that is interrupted  destroys areas of cells in a part of the brain that is "silent, meaning that it doesn't control any vital functions. Although the damage will show up on an MRI or CT scan, it's too small to produce any obvious symptoms."

A blood vessel can get blocked off, the tissue supplied by that vessel can die, but the person doesn't experience symptoms so they don't know they've had a stroke," explains Karen Furie, associate professor at Harvard Medical School and director of the Massachusetts General Hospital Stroke Service.

"That doesn't mean it's insignificant, though," Dr. Furie says. Silent strokes can cause subtle signs, such as cognitive impairment." Reseachers at Harvard confirmed a study published in the January 3 issue of the journal Neurology which looked at "more than 650 people without a history of dementia. Using MRI scans, the study authors tracked interruptions in blood supply to the participants' brains. More than 170 of the participants were found to have small areas of dead tissue from a lack of blood supply (called infarcts) in the brain, even though only 66 of them reported having had symptoms of a stroke. People with these brain infarcts had difficulties with memory and mental processes (cognition). The memory issues occurred independent of any shrinkage of the hippocampus (the part of the brain responsible for memory)—which is typically seen with Alzheimer's and other forms of age-related memory loss."

Researchers affirm that over time, the damage from silent strokes can grow larger, leading to more memory problems. "The more brain damage or injury that you have due to these silent strokes, the more difficult it is for the brain to function normally," Dr. Furie says.

"I don't think it would be cost effective for everybody to have an MRI scan," Dr. Furie says. However, she adds, silent strokes "should make people aware that it's imperative to manage risk factors." 

Those risk factors include:

• High blood pressure
• High cholesterol
• Atherosclerosis
• Smoking
• High LDL ("bad") cholesterol
• Diabetes
• Obesity
• Sedentary lifestyle
• Atrial fibrillation or Afib

News from a Swedish blog says, "While traditional strokes can be obvious and sometimes devastating, silent strokes are far more subtle and difficult to recognize. The impact of a silent stroke is smaller and typically affects less functional areas of the brain. Because silent strokes do not affect speech or movement, many people do not realize they’ve suffered one. The cumulative effects of silent strokes may lead to significant memory issues or dementia and increase the likelihood of more serious strokes in the future." The blog goes onto say that you may go your whole lifetime and never you had a stroke. But silent strokes shouldn't be regarded as insignificant. They may lead to impairment of a person’s balance, leading to more fall, temporary lack of coordinated muscle movement, loss of bladder control causing urine leakage, changes in mood and personality, or loss of cognitive abilities.

Every doctor says the same thing, and you only have to check regularly, not every week:

Eat a healthy diet that includes plenty of fresh fruits, veggies, and whole grains.

Keep tabs on your blood pressure, and get it under control if it's too high. 

Keep your blood sugar at the right levels. 

Check your cholesterol.

If you smoke, quit it instantly. 

Cut back on saturated fats, salt, and sugar. 

Get regular exercise. 

Keep to a healthy weight. 


OK. It's easier said than done. But how about now?

10 Stroke Survivor's Good Thoughts on 2019

Nothing is great anymore so, as the title says, I'll settle for good. That qualification is fine for me. Any stroke survivor who tells you differently is either lying or delusional. No in-between. Lying or delusional. That's it.

What seems like eons ago, David Letterman used to give the viewers the 10 great visions for the new year. Sometimes sardonic, hilarious, insulting, I always got a chuckle out of them, sometimes silently for fear I'd offend somebody else in the room. You never know. People are so finicky.

Anyway, my 10 thoughts for the new year are not in any specific order. And they aren't just for me. They have been carefully accumulated, begun on December 3. But here they are, just in time for the new year, with Dick Clark's Rockin' New Year's Eve playing somewhere in the background.

1.  Finish the book

I'm expecting another book to come out by the end of the year. That's not like hoping, but rather expecting. There's a difference. Hoping is meaningless; expecting is meaningful, like making a promise to myself.

2. Make good decisions

That's what my sons always tell me: Mom, you have made a bad decision again. But in my defense, some of those decisions were bad looking back with 20/20 hindsight, but the majority were about risk-taking, wanting to defy the people who told me I would put my body parts at risk: ribs, back, arm, for example. I won't defy those people again because, when it comes right down to it, I'm not the only person who gets affected. Those who love me do, too. I realize that now.

3. Create something every week that would be useful to others

My blog is useful to others, but that just comes out usually twice a month. The other part of the month I will donate chickens or goats or pigs and a whole lot more through a website called http://www.compassion.com. The website even has gifts that will be used to sponsor a single child.

4. Lose weight

I have plateaued but still want to lose more weight. That's because lighter is better when it comes to body weight and strokes or other brain injuries. Lighter leads to less falls, increased balance, and better posture.

5. Keep Life Alert

Every time I think about giving up my Life Alert necklace, I think about all those times when I needed to call for help. Just thinking about it says that the Life Alert of $49.95 will stay on my Discover statement forever.

6. Read a lot

I wasn't a big reader when I was younger, having sports dominate my life. But now as a stroke survivor, unable to participate, except for walking, in sports anymore, I have became a fan of reading, even books I never had a preference for before, like Pride and Prejudice, The Hitchhiker's Guide to the Galaxy, and Slaughterhouse Five. Plus, reading is a way of keeping your cognitive skills going strong.

7. Stop taking stuff personally

I mostly have it under control now, but at rare times, especially when I've had a stressful day, I let people get to me: Customer service representatives say, I don't have any idea what you're saying (rather than asking me to rephrase my words) or an acquaintance says, I've noticed that one of your eyes is smaller than the other (it's just plain mean and uncalled for). Dumbasses.

8. Have no regrets

Funny story if I wasn't the main character in this drama. Fifty year ago, I wanted to become a lawyer (my #1 regret). I lived at home during college (my #2 regret) and I wanted to get away from all the crazies and bullies in my house so I got married at the too-young age of 21 (my #3 regret) and gave up on my dream. So now I've decided two things: I didn't chase those dreams hard enough and I no longer want to have those regrets in my life. I'm really trying hard to take responsibility.

9. Respect grown-up children's wishes

It took a long time and therapy included, and I'm almost there, but I want my children's wishes honored. I'm protective so it follows that I always want to give advice, make "whatever is wrong" right. But they're grown now and I'm trying to stop.

10. Achieve world peace

Yeah, right. Like that's going to happen. But I can hope, right?

All these points lead to the same thing: Give a crap about what's really important and don't give a flyin' f**k about what's not. I wish all my readers the happiest of new year's yet. And remember, if you're reading this post, you survived. 

Stroke Survivors: Three Recent Studies on Fatigue That Tell How, Who, And What Respectively

I'm just speaking for me, and probably for most, if not all, of the stroke survivors. Every time I lie down, I always say the same thing, albeit silently: I don't want to take a nap. I need to take a nap. Why is that so?

In the world of acronyms, it's called PSF, or Post-Stroke Fatigue. PSF is a given post-stroke. So what is the solution? Knowing that you need a nap, there are some suggestions on management. Follow along and track the 1) how, 2) who, and 3) what respectively in these 3 recent studies.

The How

In the Chinese Journal of Physical Medicine and Rehabilitation, Yan et al wrote:

Issue: How you breathe makes a difference. 

Findings: "Diaphragm training can significantly improve motor function and the daily life of stroke survivors.The mechanism may be related to improved respiratory function and decreased severity of fatigue."

Translated from medical jargon, that means you might take shorter naps, or even a 15-minute power nap, if you breathe the correct way. I took an armchair yoga class several times and each time, the instructor went over breathing: a count of 4 breaths in (inhalation), a count of 6 breaths out (exhalations). This breathing exercise is good for other things, like alone time for meditation and frustration moments. I try to do that breathing pattern all the time, and when I forget, I know, so I get right back on track.

The Who

In the Journal of Psychosomatic Research, Cumming et al discovered a couple of things, among others, that might interest you:

Issue: Confirmation of link between FMS (Functional Movement Systems) and disability and depression

Findings: "Post-stroke fatigue was associated with lower limb mobility, while post-stroke depressive symptoms were associated with cognitive performance."

Issue: Finding of greater fatigue with increased time since stroke

Findings: "The current results underscore the importance of recognizing fatigue clinically, and the need
 to understand the underlying pathophysiology. Its importance is also highlighted by a high prevalence and persistence, remaining elevated in one study at 6 year follow-up." 

The What

In Lenus, The Irish Health
Repository, Khan and Delargy found the following:

Issue:Rehabilitation can be severely affected by PSF.

Findings: "Post stroke fatigue is a frequently reported symptom by stroke survivors undergoing rehabilitation. This cross sectional observational study was undertaken in a rehabilitation facility to look at its prevalence and relationship with various variables like personal factors, type of stroke, social context, hemispheric involvement on CT scan and mobility status. The results showed that PSF was present in 83% (25 out of 30) of the patients included in the study."

----------

Predictable, for sure. But when the medical researchers say it, you REALLY believe it. Please show this article to your family and friends if they say something negative like, "Get up already" or "Stop being lazy." PSF is a real thing.

A Remarkable Stroke Survivor's Tale: Broken Lady? Hardly!

Get ready for the extraordinary. If you want to donate, and I think you should, there's an opportunity to donate even $1! 

https://www.seedandspark.com/fund/the-great-now-what

But I know how you are. You want to be sure she's worth it. Trust me. She is. Here's Maggie Whittum's story, in her own words, and you can decide for yourself: 

I always wanted to get on stage at the Denver Center. Growing up in Steamboat Springs, it was a trek to get to Denver, but my parents really valued the arts, and made a point to bring me to the opera, the ballet and the theater. When I was 10, we made a special journey down to see The Tempest in the Space Theatre. The show was exceptional and has lived on in my mind for decades.

I thought I was going to be a professional actor, director and producer. I studied drama at Colorado College and spent much of the next seven years living abroad. In 2005, I was lucky enough to perform in a successful one-act comedy at the Edinburgh Fringe Festival. I would return to this for the epic festival in Scotland for the next three summers. In South Korea, I got to appear on a quirky Korean children’s television show. I started an improv group there that still exists. I directed several shows and worked consistently as a voiceover artist.

I was blessed with so much. But living abroad had its drawbacks, so I came back to the U.S. in 2011.

I made some inroads with Denver theater companies. I specifically remember seeing The Diviners by Phamaly Theatre Company in 2011, and being extremely impressed.

I spent a year as a producing and directing assistant at McCarter Theatre in Princeton, New Jersey, then came back to Denver for another year. Then set out to get my MFA in acting at the Academy for Classical Acting at the Shakespeare Theatre Company in Washington D.C. It was an intense and enriching program. I spent all day studying Shakespeare, scansion, stage combat, Alexander Technique, dance, voice and speech. I loved every minute of it.

Then, two days after the first semester ended in December 2014, I got a headache. Forty-eight hours later, I checked myself into the George Washington University emergency room. Two days after that, things significantly worsened. I was put on a ventilator, the left side of my body and right side of my face were paralyzed, and I had kaleidoscopic double vision.

I had suffered a massive stroke.

Terror is the word to describe it all. Piece by piece, my body stopped working. I could no longer move. I could no longer speak. I could no longer breathe. Thirteen days after that initial headache, I underwent a nine-hour brain surgery at Johns Hopkins Hospital. It was a success. I could breathe on my own again, and I went to a rehab hospital.

I thought I could get back all the things I had been before the stroke. But just as my body had crumbled before, my life crumbled after. I had to drop out of school. My engagement ended. I was not able to work for a very long time. I recognized, about nine months after my stroke, that I was now permanently disabled.

I moved back to Denver feeling destroyed and ashamed. But once I was back in town, I made a point to see all of the Phamaly productions. When I heard they were doing the musical Into the Woods, I was absolutely thrilled. I mustered up the courage to audition in January, despite having a paralyzed vocal cord. I was delighted to play Cinderella’s Stepmother.

When I finally stepped onstage at the Denver Center, it was a considerably bittersweet experience. Of course I wanted to be there, but not under these circumstances. I deal with a lot of chronic pain now, and many vision issues, but it was tremendously rewarding and validating to step on that stage and perform again. I got to make people laugh. I got to be a part of an extraordinarily talented ensemble. I got to feel seen again.

Phamaly is an extraordinary company, and I feel fortunate to live in a city where a company like that can thrive, because it wouldn’t be the same if I lived in Miami or Seattle. I can’t wait to see their newest show, Harvey, now playing through Nov. 11 at the Olin Hotel in partnership with Senior Housing Options at 1420 Logan St.

Into the Woods was a major step forward in my life. I am now creating a documentary film called The Great Now What about my experience with stroke and disability. With the support of other trauma survivors, I hope this will be a film about how creating theatre and art together can inspire a community to heal and connect with empathy, compassion and humanity.

Art heals pain.

Editor’s note: Maggie Whittum’s fundraising campaign for her film will be launched on World Stroke Day on October 29. Click here for more information (there's only a short window until November 26)

To summarize:

Steamboat Springs native Maggie Whittum is a Denver actor who has appeared in A Midsummer Night’s Dream (as Puck) and Into the Woods (as Cinderella’s Stepmother) for Phamaly Theatre Company. Previous theatre directing and producing credits include All in the Timing, The Zoo Story and The 25th Annual Putnam County Spelling Bee. She has directed and performed in Scotland, Colorado, South Korea, Taiwan, Hong Kong, Beijing and throughout Canada. She also assistant directed under Tony award-winner Rebecca Taichman at McCarter Theatre in Princeton, where she was named the Charles Evans Fellow in 2012.

Now Maggie has a new project, a movie:

    

This will be an important and impactful documentary film.

Another writer claims: Maggie has it all: brains, beauty, an education, a fiancé, and plans for a family. Then a rare stroke (caused cavernous angioma) shatters her identity, leaving her permanently disabled and with intense chronic pain, a paralyzed face, major vision issues, and more. She leaves school, loses her body, her voice, her face, her vision, her man, her money, her ability to work, and nearly -- her mind. She links up with other disabled artists and performers. Creating theatre and art together, they inspire a community to heal and connect with empathy, compassion, and humanity.

Maggie says, "We have BIG GOALS. Eventually, we hope this film will be featured at major festivals, like Sundance and Telluride, and will stream on HBOGo, Amazon Prime, or Netflix (It's very important to us this film is available via online streaming to people with disabilities who cannot leave home easily.) We are proud to say that The Great Now What has been chosen as a “Featured Project” by the Denver Film Society. We are being considered for several prestigious grants, and this crowdfunding campaign will help us meet funding goals, as well as grow awareness and enthusiasm for the film!"

Here is the way to donate: 

https://www.seedandspark.com/fund/the-great-now-what

Much appreciated! We are at 67% of our goal!

Our $41,000 goal is the bare minimum needed to to complete a film that we are proud of and can release online.

If we raise $50,000, we'll be able to create much more elaborate and compelling motion graphic animations to communicate life with chronic pain!

If we raise $60,000, we'll be able to hire the very best marketing and promotional team to help us reach as many stroke survivors, people with chronic illness and chronic pain, caregivers, and people in the medical community as possible!

"If we raise $70,000, we'll show the world that people with disabilities are not invisible! We'll have more leverage when negotiating with distributors, and we'll be to acheieve a bigger platform and have a major (worldwide!) impact!

"If we raise $250,000 we'll be able to create the best film possible, reach the widest audience possible, fund all of our post-production costs, AND fund all our film festival entry fees, distribution costs, promotional travel, marketing, audience outreach, and make the most powerful and deeply empathetic film that will impact stroke survivors, people with chronic illness and chronic pain, people with disabilities, caregivers, the medical community, and so many more!

"If you are interested in making a tax-deductible donation or investing in The Great Now What, please email us at: thegreatnowwhat@gmail.com. Let's discuss!"

OTHER WAYS YOU CAN HELP

1. FOLLOW US ON SOCIAL MEDIA!

Like our page on Facebook for daily posts about the film, and relevant articles, podcasts, and pictures on disability, stroke, chronic pain, facial paralysis, cavernomas, and more! Encourage your friends to like us too!

2. SPREAD THE WORD ABOUT #TheGreatNowWhat

Tell you friends, family, colleagues, and neighbors about the film - in particular, we want to reach stroke survivors, people with chronic illness or chronic pain, people with disabilities, and members of the medical community. Share our posts, campaign page, and our backer updates! Tweet about us! Here is a sample Tweet!

Join #TheGreatNowWhat #crowdfunding campaign; help make this powerful #documentary #film on #stroke #disability a reality!

Contributions can be sent to: http://www.seedandspark.com/ fund/the-great-now-what

3. JOIN OUR MAILING LIST!

Stay up to date on the film - click here to join - we won't spam you.!

4. KEEP FOLLOWING OUR CAMPAIGN!

Regular visits to our Seed&Spark page keep you in the know AND increase our chances of being featured on the site!

I know most stroke survivors don't work anymore, with no money coming in except Social Security. But there's always a dollar that you can contribute to this remarkable effort. Maybe more. There are almost 800,000 people who have strokes every year, and that's America alone. If everyone contributed a dollar.... You get the gist. 

https://www.seedandspark.com/fund/the-great-now-what

To Boldly Go Where No Insect Has Gone Before: Fuckin’ Fungus Gnats

The first part of the title is self-explanatory, but the altered line from one of the most extraordinary shows, Star Trek, requires some explanation. So keep reading. Once you're done, you'll understand. Now, on with the story.

I had a stroke. No revelations there. And as such, I cannot get out whenever I feel like it to buy things, more specifically plants. So I ordered live plants from Amazon, and that's when it started--tiny, annoying, fuckin' (yes, the profanity is necessary) fungus gnats. First, some background. 

The adult fungus gnat can lay about three hundred eggs in its short lifespan, about two weeks, unless you're lucky enough to smash one. (PETA people, forget it. Even you would find them annoying). Eggs are laid in fertile, moist soil at the base of plants and turn into larvae, rapidly increasing in size as they munch through organic matter in soil.

If you overwater the plants, too much wetness will propel the development of fungus gnats and the roots will begin to rot, making the ideal meal that fungus gnats love. In addition, you might find the fungus gnats enjoying the plants themselves if there's not any organic matter (dead, decomposed worms, for example) left. 

A root drench with one part hydrogen peroxide and four parts water (you have to wait until the mixture runs all the way through the plant and out the drainage hole) is best rather than spraying the plants with insecticide because it rids the problem. You'll have to put up with the gnats for two weeks longer if they've already hatched.

Two weeks ago, there was an infestation before I read about the hydrogen peroxide mixture. So the African Violets and the poinsettia plants, which are very susceptible to fungus gnat damage, didn't succeed. But so far, the other plants came through the process.

And now, To Boldly Go Where No Insect Has Gone Before, will be revealed. 

I have sinusitis and use a nasal rinse (which is disgusting in itself and I lock the door by habit, even if I'm alone, to not let anybody observe), and at the start of the infestation, I noticed fungus gnats were coming out of my nose in hordes. The more I used the rinse, the more I saw the fungus gnats emerge, nasally speaking. Unbeknownst to me, and definitely the fungus gnats, I was inhaling the gnats (I'm going to get dramatic here) with every breath I took. 

So for a week thereafter, I wore a surgical mask 24/7 to keep the fungus gnats from being sucked up into my nose. But I have a few more orifices, like my ears and eyes, for example, and I used appropriate rinses in them, too. 

Takeaways? Don't buy live plants live plants from Amazon and definitely don't buy live plants from a greenhouse in the fall or winter when the fungus gnats are more plentiful, burying their fragile eggs in the moist soil to keep them warm and thriving. 

But Andy and Laura, my son and his girlfriend, bought me a Venus Fly Trap for the remaining gnats, that really does what it says. Look carefully. The picture says it all.