This Is a Life Lesson: Cankerish Braces Just a Parable

This post is divided in 3 parts. If I had to judge, the 3rd part is the most important. A little background first. 

Part 1:

When I had my stroke at 4am on April 8, 2009, the paramedics came and I was soon intubated, I found out a few months later. Intubation is a procedure where an endotracheal tube offers an open passage through the upper airway to allow air to pass freely to and from the lungs in order to ventilate the lungs. It helps to be in a coma-like state to not feel the pain.

Endotracheal tubes can be connected to ventilator machines and is often used when patients are critically ill and unconscious, and cannot maintain enough respiratory function to keep breathing on their own.

During endotracheal tube placement, however, one of the dangers is damage to the teeth. So one of my teeth, the upper right canine, was missing, as in knocked out. Also, I had orthodontia before many years ago and the original orthodontist placed a wire behind my bottom teeth so they wouldn't move, and the wire became dislodged in placing the endotracheal tube. I had the upper right canine replaced with a cap, but the lower right first molar eventually came forward in time and my bite was affected.

I studied the tooth, coming forward each year, until I couldn't stand it any longer. That was the only thing I could see in the mirror--that medial drift of the molar which made room for the rest of the teeth, but the hapless lower left first molar was the victim.

The new orthodontist applied the braces and said, "Remember. Nothing hard or crunchy or sticky while you have the braces on." I sat there and started thinking about Vitamin K and Coumadin, a popular blood thinner.


Part 2:

I have to take the same amount of Vitamin K in order to keep my INR (International Normalized Ratio) stable. Vitamin K is responsible for a healthy heart, improvement in bone density, reduced infections, and strong teeth. The INR determines ability to clot and, according to WebMD, "People taking the blood thinner warfarin typically have a target INR of 2.0 to 3.0." Below 2.0, you're aiming to clot; above 3.0, you might bleed. Trust me. I was there, and you don't want either.

I found inrtracker.com and then simply clicked on Vitamin K database to see which foods were allowed, not more than 90 micrograms a day for people 19 and older. This was my regimen, i.e. the same foods I ate every day. I absolutely love cucumbers with the skin still on them (4 thick slices = 30mcg), stalks of celery (1 large = 30mcg),  and blueberries (1 cup = 30mcg).

But I can't eat them now, the cucumber and the celery because they were hard, and especially blueberries getting stuck in the braces because of the outer skin. I felt so defeated that my regimen couldn't exist for a while.

But then, a week later, I researched and while I have the braces, I eat chopped cabbage for cole slaw that's made soft in the mayonnaise dressing (1 cup = 32mcg), ripe "just-melt-in-your-mouth" avocado (just short of 1 cup = 28mcg), and 1 large, soon-to-rotten kiwi (1 = 30mcg), every day. The regimen must continue, for the canker-producing braces, for the must-have Vitamin K, for my anxious sanity.


Part 3:

Until the braces come off in 5 months, I'll go with that regimen every day. Good Lord! It's only 5 months! I'll keep my INR between 2.0 and 3.0, and then I'll go back to the cucumbers, celery, and blueberries once the braces come off.

You see, it isn't the braces alone that's the reason for my telling you the story. It's a parable, an allegory, that applies to everything in life you consider arduous and burdensome. For me, it was assigning other "edible-because-of my braces" foods to my Vitamin K diet with Coumadin. For others, it might be a word you couldn't utter, and now you can speak that word without feeling embarrassed, or a walk around the block that you deemed impossible, and now you can do it twice, or a 12-minute ride on the stationery bike that you thought was the most you could do, and now you can do 55 minutes.

Bottom line? You can do more things faster and efficiently than you're doing presently. Guaranteed. I know because, as a stroke survivor, I was there.

Botox and Stroke Survivors: Does It Really Work?

First off, I have to tell you a story about Botox.

A year after I had my stroke in 2009, I went back to the acute care hospital--Bacharach Institute for Rehabilitation in Pomona, New Jersey--to see a doctor who specialized in spasticity of the limbs or, in my case, my leg. I wrote the book, "The Tales of a Stroke Patient," in part about Bacharach and called Bacharach Rehab X (now that I don't need them anymore, I'll reveal the source), and the insensitivity at times of the health professionals there--doctors, nurses, CNAs. I shouldn't have gone back. But the spasticity was driving me crazy.

If you think about it, you might not get the injection. The word Botox is a combination of botulism and toxin (OnabotulinumtoxinA the active ingredient contained in Botox). Botox comes from a bacteria that is a type of botulism, a type of food poisoning which, if you inadvertently use spoiled beef, can cause you to become very ill if ingested.

Anyway, I heard about Botox (the famous drug used to tackle wrinkles and lines for the insecure Hollywood folks) to also reduce spasticity and I made an appointment with Dr. X who specialized in Botox injections.

I went into the procedure room and the doctor followed. After we greeted each other, I asked him about the side effects.

I thought, C-mon. Botox wasn't to make me look younger. I HAVE A LEG SPASM, FOR CHRIST-SAKE! THEY'RE FUCKING PAINFUL AND ANNOYING! 

The doc said, without missing a beat, "You may die."

I paused and then shrieked, almost simultaneously, "Not today!" and quickly hopped off the table and ran (for a stroke survivor, "ran" is an exaggeration) out of the room, leaving the doc with his needle, the longest needle I've ever seen in my life, already about to inject the "death" serum into moi.

As it turns out, after much recent research, "death" isn't listed on the drug's bottle. Back pain, body aches, difficulty breathing, trouble swallowing, coughing, headache, and fever are among the possible side effects. And death? Never. 

But it should be. The doctor was right. I could die from Botox if it wasn't injected directly in the muscle and went to other parts of my body. Remember? A toxin? But he mocked and scared me, taking advantage of my nervousness.

Public Citizen's (PC) Dr. Sidney Wolfe demanded that the FDA  order a "black-box warning," to require that every patient receive a pamphlet outlining the risk prior to the Botox injection.

"What we're saying is, nobody should be dying of Botox, and they wouldn't be dying if the government and the companies were doing a better job warning people," Wolfe said. (The good doc's message came true. The warning is now on the bottle though PC discovered 16 deaths specifically related to Botox ten years ago. There are most likely more now). 

So insecure people wanting to look younger and more vibrant aside, exactly how does Botox work with brain-injured people? 

A spinal cord injury site said, "A small dose of Botox injected directly into the spastic muscle(s) blocks the acetylcholine so that the muscle can loosen and relax, resulting in increased flexibility and mobility and reduced pain." 

Relief comes to many within three to seven days following an injection, typically lasting three to six months, so injections that are repeated is normally needed. And check to see if the Botox (I mean, ask the doctor to show you) is manufactured by Allergan and not some counterfeit drug company.

Botox is not a cure, and your symptoms will slowly return as the effects of the medication subside.

A recent study at Indiana University found the benefits of Botox in reducing spasticity in the arms and fingers were roughly twice as effective as those who didn't get Botox at all.

Published in The New England Journal of Medicine, half of stroke patients, 126 in number, received injections of 240 units of Botox and half received placebos. The conclusive evidence said the 62% of those who were given Botox injections found relief in their spasticity, while only 27% of the patients taking the placebo reported improvement. Then again, there's mind over matter often taking effect.

The reason that I am thinking about Botox at all is that on this day, 8 years ago, I had my stroke. And I still have spasms, less often, but when I get them, they are mind-altering. 

I'll call for an appointment on Monday, or the week after that, or perhaps never. That sounds about right--never.

Cigarettes, Second-hand Smoke, and Even E-cigarettes (aka Vaporing) Can Give You a Stroke, aka You're Playing With Fire

My mother who didn't work used to smoke a lot, notably in the bathroom where she said smoking would hide the smell of poop. (It didn't, in my opinion). She also smoked for hours on end when she was talking to "Aunt" Eleanor, her best friend. She smoked when she sat outside at night in the 1950s and 60s with the neighbors--the Craigs, the Scotts, the Lynches, the Groffs, the Baldinos--and she smoked when she was preparing every decorative, Betty Crocker-like meal, and a few cigarettes after, because she said cigarettes were relaxing. 

She most likely smoked more when we were at school. She probably smoked a pack or more of cigarettes daily for 45 years, and she didn't get cancer, or emphysema, or high blood pressure, or any--but one--of the things that smoking a pack or more of cigarettes daily for 45 years will give a person. She got a stroke.

Heart disease and stroke are often glopped together because they fall into the category of cardiovascular (heart and blood vessel) diseases (CVDs). 

In the United States, heart disease includes the most common type--coronary heart disease, which is narrowing of the blood vessels that carry blood to the heart. The narrowing can cause chest pain, arrhythmia (when the heart beats irregularly, too fast, or too slow), or heart attack (when blood flow to the heart becomes blocked and a section of the heart muscle is damaged or dies), or heart failure (failure to get the organs to survive because the heart cannot pump enough blood and oxygen).

Similarly, a stroke occurs when a blood vessel in the brain bursts (hemorrhagic stroke, which is the kind I had), causing brain tissue to die, or when the blood supply to the brain is blocked (ischemic stroke). Stroke is one of the leading causes of disability, or even death.

Smoking is one of the major causes of CVD and results in one of every 3 deaths. Smoking can: 

1. Increase the buildup of plaque in blood vessels
2. Cause thickening and narrowing of blood vessels
3. Make blood thick and more likely to clot
4. Raise triglycerides and lower good cholesterol (HDL)

Even if you don't smoke, second-hand smoke, the smoke from a smoker breathed out by burning tobacco products, harms your health, too. 

Breathing secondhand smoke can cause coronary heart disease, including heart attack and stroke. I've already told you about my mother. And my father smoked cigars. I was doomed. Here are the highlights:

1. Each year, second-hand smoke exposure causes more than 8,000 deaths from stroke. 
2. Nonsmokers who breathe second-hand smoke at home or at work increase their risk of developing heart disease by 25–30%. 
3. Second-hand smoke increases the risk for stroke by 20−30%.
4. Even briefly breathing secondhand smoke can damage the lining of blood vessels and cause your blood to dangerously thicken.

The most alarming news in a recent study has found that people using e-cigarettes may be at higher risk of a life-threatening stroke than ordinary cigarette smokers.

Why? Here's how E-cigarettes work. They work off of battery-power that when drawed on, aka inhaled, gets liquid nicotine into an inhalable vapor. The vapor doesn't have the chemicals and tars of addictive burning tobacco, and so e-cigarettes were initially considered safer than cigarettes.

But recent research at Johns Hopkins University used mice who were exposed to e-cigarette vapor for 2 weeks and were found to have greater nerve damage, and their lungs were less capable of fighting off viral and bacterial infections when compared to mice not exposed to the vapor.

One researcher said, “Vaping is not safer than tobacco smoking and may pose a similar, if not higher, risk for stroke severity. Stopping smoking is the single most important step you can take to improve your heart health."

The British Heart Foundation is funding research to find out "whether or not they are as safe as people think.” The devices are targeted at helping people quit smoking cigarettes, but they have been ironically called the “gateway to smoking.”

A study reported in February 2017 said that e-cigarettes may be just as detrimental for your heart as smoking ordinary cigarettes. The researchers observed that vapers were more likely to show signs of two key heart risk factors: increased levels of the hormone adrenaline in the heart and increased oxidative stress (an imbalance between the  oxygen and the body's willingness to detoxify or to repair the resulting damage).

E-cigarettes were introduced around 10 years ago and currently have about 9 million users.

The Centers for Disease Control and Prevention (CDC) reveals a shocking increase in nicotine poisoning incidents, which "can be toxic, even fatal, to children even in small doses." Additionally, inhaled nicotine increases heart rate and blood pressure, one of the major causes of stroke.

The Food and Drug Administration in a remarkable move in May 2016 administered legislation extending federal authority over e-cigarettes. "This action resulted in banning their sale to anyone under 18 and requiring adults under 26 to show photo identification," The New York Times reports.

People reading my post won't necessarily stop smoking just because I said to stop. And they won't necessarily stop smoking just because some health professional told them to stop. People are funny like that. They'd probably only stop smoking when something catastrophic happens to them. Like a stroke, for instance.

NOT BREAKING NEWS: Somewhat Crazy Twice?

Years ago, I was with a friend whose son developed panic disorder from smoking weed. The 22-year-old son had the presence of mind to come to my friend's house. He was lying on the sofa, almost breathless, crying intermittently, begging for help. My friend, who was his father, talked patiently and helped calm him down in two hours. For some of you, maybe talking a mental disorder through will help also, and be enough.  But start at the hospital ER if talking doesn't fix the problem. Mental conditions can be rougher than a stroke! "Head stuff" almost always is. 

Years later, I wondered about mental disorders as related to stroke, and this article popped up. Under the title, Study Links Psychiatric Disorders to Stroke Risk, comes this disheartening news from National Institutes of Health (NIH), published on February 23 of this year:

"Getting care at a hospital for a psychiatric disorder may be linked to a higher risk of stroke in the following weeks and months," new NIH research suggests.

Oh, great, another reason to worry, especially for people who already have depression, anxiety, or post-traumatic stress. Now they might have both--a stroke and one of the aforementioned. Here's what the researchers  found out.

People with mental conditions, stroke or no, possessed a triple threat of stroke--or another stroke--following their stay in the in-and-out ER or for a prolonged stay in hospital bed.
 
The threat of stroke began to decrease after 30 days, but "remained twice as high for at least a year after the ER visit or hospital stay," the researchers discovered.

"We have known for some time that people who have a stroke seem to be at an increased risk for later on developing some sort of psychiatric illness, depression or post-stroke psychosis," said the lead study author, Jonah Zuflacht.
 
Zuflacht went on to say, "But what has been less studied is the inverse of that. Meaning, if you have some sort of psychiatric illness, does it increase the risk for stroke?"


The conclusion? The ER visit or hospitalization for a psychiatric disorder was associated with a higher risk of stroke. The research team said the body might go into overdrive with a "fight-or-flight" stress response, elevating  blood pressure, a leading cause of stroke.
 
"The other possibility,"  Zuflacht added, "is that there are behavioral reasons at work. For example, are these patients not taking the medications they should be taking to prevent a stroke--like their high blood pressure meds--because of their mental illness?"
 
The study from California's Healthcare Cost and Utilization Project analyzed more than 52,000 stroke events--equally divided between men and women--that had taken place between 2007 and 2009.
 
The team discoved that more than 3,300 patients (or 6%) had hospital care for a psychiatric illness at some point in the year leading up to their stroke and were more likely to be female. 

The risk of stroke tripled within the first 15 days after receiving mental health care and dropped slightly afterwards, but was still more than triple the normal rate of having a stroke one month out, with the risk more than double the norm through the 12-month period.

It's not surprising to me, though, and I think it's more than an increase in blood pressure. The psychiatric illnesses may result in other things, too, like increased eating of junk, aka fast, food (http://stroketales.blogspot.com/2013/04/hey-can-fast-food-in-abundance-really.html), going on alcoholic binges (http://stroketales.blogspot.com/2016/09/alcohol-and-stroke-you-may-be-just.html), or elevating your cigarette smokes (post eventually coming), all causes of stroke.