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. 

Be Honest, Caregiver: Serious Profession or Work-Shy Pastime?

Some of you have caregivers who are spouses, family, friends, and if they're good spouses, family, friends, they'd offer the world to see you thrive. I'm not talking about them. I'm talking about hired caregivers who only work for you to make caregiving into a living, caregivers who only work to meet the mortgage or the rent or some other bills that need to get paid. 

Let's look at this logically. Caregiving is one of the few professions where you can--poof!--just become one, training be damned. For the decent ones, I've had, in the eleven years since my stroke, over thirty caregivers, virtually genuflecting to them all to not have them quit.

I fired five of them. They are the following:

I've had a caregiver who was on drugs (I saw labeled cocaine in a plastic baggie, lying among her possessions which she
 brought to work and acted like a schizophrenic with her
 disorganized thinking, delusions, and hallucinations); 

and a caregiver who didn't ask if she could bring her children,
 and then she did (they were rambunctious twin 6-year-old
 boys who whined about lunch for hours, which I bought for them just to stop moaning); 

and the caregiver who would yell at me in sort of dark,
 comedic fashion and laugh as if she was committing elder abuse (I didn't think that's funny); 

and a caregiver who went on eating her strawberry salad
 while we we were out shopping after I fell off the smooth,
 glass-like chair (people around me got up to assist me while
 the caregiver continued picking at her strawberry salad);

and finally, a caregiver who eagerly wanted to work, and
 then, a week later, told me she had diarrhea constantly and
 couldn't work anymore. (Did the diarrhea just start a week
 ago? I wonder.)

Then in January 2020, eleven years later, I achieved the impossible: a caregiver that was a registered nurse at a prominent hospital who retired from her job and was continuing to look for ways to help people. I hired her and was jubilant until one day a month ago, she said she was offered a full-time job to work with a woman who had Alzheimer's, and twice the money I was paying her. I encouraged her to take the job because I couldn't even come close to the family that was offering so much.

She helped me interview new caregivers and I chose two. One was state-certified, meaning she had training on the process of becoming a caregiver, the first for me ever. The other was a seminary student.

"You could always trust a seminary student," the nurse said.

I just shrugged, thinking about all those priests who did the unthinkable. 

But she, too, turned out fine and she demonstrated to be a good person. They've been working since the retired nurse wanted to take the other job. 

So if you don't like your caregiver, there's more to be had, if they're not your spouse, family, friends. Otherwise, you're sort of stuck between a rock and, well, another rock. 

Alcohol and Stroke, or Was My Grandfather Pickled and Other Stuff

My grandfather came from Austria, the home of Schnapps, which he drank at every opportune time, some a week long, of the Jewish holiday regimen. And some after Saturday services. And some before bed. I mean, it was constant. Coming from the German word "obst" meaning fruit, Schnapps was his favorite beverage, and here, as an immigrant, he put cherry or apricot preserves in the Schnapps just as they did "back home."

Schnapps is any of various strong, dry, distilled liquors commonly with a fruit flavor, and has high alcohol levels of 30% or higher, but my grandfather never got drunk, or maybe he was always drunk and my young eyes couldn't see it because that's how he was all the time. Though despite his choice of "diet," he was healthy and lived until 96. Go figure. 

But not everybody is so lucky. Alcohol in steady and huge amounts contribute to stroke risk, and now I know why. Aside from high blood pressure (the most prevalent), diabetes, and atrial fibrillation, all factors in stroke risk, excessive drinking can cause liver damage, and stop the liver from making substances that help your blood to clot. This factor can increase your risk of having a stroke caused by bleeding in your brain, thus a hemorrhagic stroke or, by some interpretations, an aneurysm. 

By the way, in 49 of the 50 states, and the District of Columbia, the legal limit for driving under the influence of alcohol is 0.08. In Utah, the legal Blood Alcohol Content (BAC) limit is 0.05. Commercial drivers have a limit of 0.04. Any detectable BAC is a violation for individuals under the age of 21.

The Dietary Guidelines recommend that if alcohol is consumed, it should be in moderation—up to 1 drink per day for women and up to 2 drinks per day for men—and only with adults of legal drinking age.

The National Highway Traffic Safety Administration lists these effects on driving at different blood alcohol content levels:

• 0.02 BAC: You are likely to feel relaxed and have some
•  loss of judgment. You aren't able to quickly track the
•  movements of other vehicles, pedestrians, or animals. You
•  lose some of your ability to do two things at once, so you
•  are more likely to be distracted.
• 0.05 BAC: You begin to exhibit loss of small-muscle
•  control, such as being able to focus your eyes, and you
•  can have lowered alertness. You have even worse ability
•  to track moving objects. Your ability to steer is degraded. If
•  an emergency situation develops, such as needing to
•  brake quickly or maneuver around an unexpected
•  blockage, you are likely to have a poorer response.
• 0.08 BAC: You will usually exhibit poor muscle
•  coordination, loss of balance, slower reaction time, slurred
•  speech, loss of acuity in vision and hearing, difficulty in
•  detecting danger, and impaired judgment, self-control
• , reasoning, and memory. When driving, you have difficulty
•  with speed control and recognizing and reacting to signals
•  and emergency situations. You have an increased risk of
•  injuries in general, and particularly those related to driving
•  a vehicle.
• 0.10 BAC: At this level, you will have further deterioration
•  of your abilities. It will be hard to maintain lane position
•  and to brake when needed.
• 0.15 BAC: You will have poor muscle control and ability to
•  balance. You are likely to vomit. You will have significant
•  problems in controlling your vehicle and paying attention.

With the holiday season just around the corner, and if your family and friends like you, have a care and keep them happy by not having a stroke from excessive drinking. 

Luck surely came to my grandfather.