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?

Don’t Know Why You Had a Stroke? Maybe The Following News Will Help.

I didn't drink in excess, or smoke, or have diabetes, or have high cholesterol, or high blood pressure, or obesity, the main reasons why people have a stroke. I'll get to point, eventually. But first, some background.

Congenital Protein C or S deficiency is an inherited disorder. This means it is passed down through families. Congenital means it is present at birth.

The disorder causes abnormal blood clotting. One in 300 people has one normal gene and one faulty gene for protein C deficiency. Protein S deficiency is much less common and occurs in about 1 in 20,000 people. But overall, it's frequent, considering there are about 330 million in the US alone.

If you have this condition, either deficiencies of S and C, you are more likely to develop blood clots. The symptoms are the same as for deep vein thrombosis (DVT) and include:

Pain or tenderness in the affected area
Redness or swelling in the affected area

Warm around affected area

The diagnosis during the first year, when I was in the dreaded Bacharach Rehabilitation Hospital in Pomona, New Jersey, the doctor said I had a Heparin reaction, known as Heparin Allergy (that is a misnomer since it's not an allergy at all in the most practical sense) that caused my stroke. Another doctor a few years later said he couldn't give me a reason. The fifth hematologist gave me the information: I had crummy genes that produced deficiencies in Proteins C and S from most likely my mother and father. And now you know.

Medscape's Mohammad Muhsin Chisti, MD, says, "Protein S is a vitamin K–dependent anticoagulant protein that was first discovered in Seattle, Washington, in 1979 and arbitrarily named after that city. The major function of protein S is as a cofactor to facilitate the action of activated protein C.

"Protein S deficiency may be hereditary or acquired; the latter is usually due to hepatic disease or a vitamin K deficiency. Protein S deficiency usually manifests clinically as venous thromboembolism (VTE)." Stroke, in other words.

The National Institutes for Health (NIH) says, "Protein S functions as a cofactor of activated Protein C. Its deficiency is a rare condition and can lead to deep vein thrombosis, pulmonary embolism or stroke. Protein S deficiency manifests as an autosomal dominant trait." [Explanation needed: To have an autosomal recessive disorder, you inherit two mutated genes, one from each parent. These disorders are usually passed on by two carriers.]

But the good news is there's a test for Protein S and C deficiencies, and who wouldn't want to know! A family member who shall remain nameless heard of my research into Protein S and C deficiencies, but he allowed the doctor to talk him out of it like the ostrich-head-in-the-sand approach.

If you really knew of those Protein S and C deficiencies, wouldn't you change your lifestyle a bit, like cut out all the causes mentioned in the very first paragraph?

As I wrote in Northwest Brain Network newsletter recently:

Stroke is an event usually caused by rupture of a blood vessel or blockage by a clot, resulting in the lack of supply of oxygen and nutrients, and damage to the brain tissue. Even if you are not a candidate for stroke, or don't know why you had one, this news might help you.  Deficiency of Proteins C and/or S can lead to bleeding, but the good news is there is a test you may consider if you develop a blood clot and have a family member who is healthy with a deficiency of one or both of these natural anticoagulants. Testing healthy relatives of people with a natural anticoagulant deficiency of C and S has advantages which may include increased awareness of the risk factors for and symptoms of blood clots. Recognizing the symptoms of a Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) allows for prompt treatment to minimize the risk of lasting side effects. It is important to work with your doctor to understand your individual risk, preventive strategies including not smoking, lowering your weight, and achieving cholesterol and blood pressure in the safe range, and therapeutic options in the event of a DVT or PE from deficiencies of Protein C and S.

A Stroke Survivor’s Thoughts About Happy New Year? Meh.

For those of you who know what meh is and if you think this is a negative post, it is. But please read on anyway. 

After four years of Trump and the pandemic coming near the end of his single-term administration when you just wanted to scream "enough despicable Trump and his know-nothing  offshoots  already," and working at home with the kids running hither and yon inside your house because the virus is lurking in corners we don't even know about yet, and massive unemployment that isn't going to get better anytime soon, it is my belief that a portion of Americans aren't going to cheer in the new year like in years past. 

Meh is defined as lacking interest or enthusiasm. And that defines me. So I have 5 New Year's resolutions, in no particular order, rather than my customary 10, because meh-ness has overtaken me. 

1.  I'll finish my third book--fiction, this time. I said that last year and started to "finish" countless times, but I started over in 2020-- countless times. Now, I know the path.

2.  I won't let my frustrations irritate me like I did in the past. Getting my sock on with the heel on top, or having someone finish my sentence for me, or responding to a customer service rep three times with my birth date--it's all gone where I used to purposely kick anything that was near me.

3.  I'll keep doing my exercises, albeit every time I fell in the past, my recovery would take at least two weeks, setting me behind the goal I set for myself. But now I'm in a transport chair so I don't fall anymore. Yet.

4.  I'll watch Poldark--I've already seen it 12 times in a row--until I can know the lines just before they're said. (Shut up! That's my relaxation to get me thinking about #1 on this list). 

5.  I'm getting used to the new normal because it's going to be around for I-don't-know-how-many years. I remember my mask upon leaving and stay at least 6 feet apart in the line at Trader Joe's which is my only destination. I get excited when multiple avocados come in a tiny bag of their own.  And I am obsessed with the depiction of the coronavirus. Something so evil shouldn't be so attractive. What a life I now have.

I feel about the new year like I feel about most things now. Meh. But I'll force myself to wish you, my faithful readers, a happy new year.