An Article and a Presentation: Long-term Care and a Stroke Video Project

I know, I know. Insurance companies have a dismal reputation because most of them deserve it. They talk insurance speak--of deductibles, annuities, disability income, expense ratio, hospital indemnity coverage--as if everyone is supposed to understand. And the acronyms the insurance companies use will drive you "mad."

So listen up, family and friends: If you already had a stroke, it's too late to buy Long-term Care insurance, but if you're healthy, you can't make a better investment. That's why I'm guest hosting, albeit and thankfully dummied down, an article by Hazel Bridges that I think is worthy of attention. The author's views are her own. Here it is, from AgingWellness.org:

Every American who reaches age 65 qualifies for Medicare. You can rest assured knowing that your or your loved one’s medical needs will be covered by this government-subsidized health care program. What you might not realize is that Medicare doesn’t cover every need for seniors.

There are two types of Medicare: Original Medicare and Medicare Advantage Plan (Part C). Under original coverage, there’s Part A for hospital care, skilled nursing facilities,
hospice, lab tests, surgery and home health care; and there’s Part B for medically necessary services and preventative services. Part C falls under private insurance with Medicare approval, and the out-of-pocket costs are lower than original Medicare.

What might interest you is what Medicare doesn’t cover: eye exams, dental care, cosmetic surgery, foot care, hearing aids, acupuncture, or long-term care. 

Long-term care (LTC) is especially important to understand because many seniors need this later in life for several years at a time and not everyone plans for it. Long-term care usually refers to custodial care, which is help with daily living. This includes activities such as getting dressed, eating, getting around the house and medication assistance. Since most of these needs are not medical, Medicare generally doesn’t pay for it.

Long-term care can take shape as home care by a skilled nurse or home caregiver without medical training, but it can also involve long-term stays at facilities. Some seniors prefer (and are able to) remain at home with help, but other seniors either don’t have long-term living arrangements or are unable to live outside of a facility that can provide 24/7 care. This is where assisted living facilities and nursing homes come in.

Medicare only covers long-term care under certain circumstances. Skilled nursing care has to be short-term (100 days or less), preceded by a hospital stay, and as recovery from an illness or injury that’s not from a chronic condition. There’s also a helpful program called Medigap, which is an insurance supplement from private insurance companies to cover the gap that Medicare doesn’t cover.

Unless you’ve thought about your retirement years in advance and have all your ducks in a row, you might find yourself struggling to cover the costs of long-term care. Perhaps you’re a junior who is taking care of an aging family member who needs long-term care, and you don’t know what your options are. Or, maybe you’re simply looking into a plan for your own future LTC needs.

Whatever your intention and needs are, you can plan ahead for LTC. If you’ve already reached that point, you can find ways to subsidize the cost with your current income and assets. The most direct choice is long-term care insurance, which does exactly what it says: pays for long-term care. These policies are typically taken out after age 50, years before the service is needed. A healthy 60-year-old can also take out a policy, but your premium rises as you get older or have a condition that could require LTC later down the road.

If cash is needed to help pay for long-term care, one popular option is a reverse mortgage. In a reverse mortgage loan, homeowners can convert the equity in their homes into cash. The lender makes tax-free payments to the borrower since it’s a loan advance rather than a form of income. Just be careful to weigh the pros and cons of this decision.

You may have a long future ahead of you, or you might find yourself trying to make ends meet for yourself or a loved one. Whatever your situation, make sure you understand what your insurance policies cover, how Medicare can help you and how your assets can be converted to cash. You have one life, and you should take care of it as best you can.

Congrats, Hazel, for this informative article. 

And I received this stunning email from Maggie Whittum:

Hello Joyce, my name is Maggie and I'm a stroke survivor and filmmaker. I had a massive stroke at age 33, leaving me disabled. I'm hoping to do something good with my shattered life.

I wanted to tell you about this documentary film project of mine.
Please check out this two-minute teaser.

I'm trying to convey to people what my life is like with 

pain/disability/a shattered sense of identity.

https://vimeo.com/244729372

It's a documentary film on stroke, disability, loss, 

resilience, and the healing power of art. It’s for  

stroke survivors, and people who struggle with 

chronic illness or chronic pain.  

If you would like to share it with others, please do.

Thanks for all that you do!

Maggie

Wow! A filmmaker and a stroke survivor, attempting to
make a difference from her shattered life. Kudos, Maggie,
for an ongoing project very well done! Best wishes!

You can leave comments below for Hazel and Maggie.
I'll pass them on.

The Reason I Had a Stroke: Protein S Deficiency, aka Lousy Genes Will Get You Eventually

My mother, bless her deceased soul, used to have her favorite vegetable at dinner for us most of the time: overcooked string beans, and I, following in the tradition of my mother, use to serve the same thing when I married, dried out and sorry-looking green beans that looked as if they had died last week.

Anyway, overcooked string beans provide little, or none, of the beneficial nutrients. And I ate them, too ignorant of nutrients as a child to care. As an adult, I tended not to have vegetables, except those overcooked green beans, always on my shopping list. So I developed Protein S deficiency, unknowingly to put me right in line--eventually--for a stroke. I was not aware of that deficiency for 55 years.

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) Joshi and Jaiswal said, "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.]

There's a test for Protein S and C deficiencies, but would you really 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 ostrich-head-in-the-sand approach. 

On the other hand, if you really know of those S and C deficiencies, wouldn't you change your lifestyle a teeny bit, like eat more vegetables, raw even, and foods high in Vitamin K? 

Foods rich in Vitamin K are bearable, some even delicious:

• kale
• collard greens
• spinach
• turnip greens
• Brussels sprouts
• broccoli
• asparagus
• lettuce
• sauerkraut
• soybeans
• edamame
• pickles
• pumpkin
• pine nuts
• blueberries

Here's another view:

Check with your doctor and see if approval for Protein S and C deficiencies testing is do-able. Insist, even. Strokes suck in ways your wildest dreams can't imagine.

Why Do Stroke Survivors Lose Friends?

Through my involvement with stroke survivors at all levels, I heard from a lady who had to move 2000 miles away to get out of an already horrid relationship. Reason being, she was under so much stress that once she had the stroke, the situation was unbearable. The distance was worth it for two reasons, I imagine: the distance put, well, distance between her and him AND she is happily situated now, 10 minutes away, near her daughter. I'm a sucker for stories with happy endings.

My online stroke support group works on giving me distance, too--to stay away from people who can't tolerate that I'm different than when they knew me before! First, some research on why the intolerance.

Studies say it is predicted that by 2030, there will be 12 million stroke deaths and 70 million stroke survivors. It stands to reason that many stroke survivors feel unsupported. So the questions remains, can the complex needs of survivors and families and friends cope with the aftermath of stroke? Or any type of brain injury, for that matter.

It is estimated that up to one-third of survivors will have communication difficulties including aphasia, dysarthria, or apraxia of speech (language comprehension, producing speech, and/or difficulties with reading and writing). Research says stroke survivors with communication problems aforementioned may have difficulties living in a community with those that don't have such problems, resulting in a poorer quality of life and not joining activities of daily living. Furthermore, evidence of the survivors are also more likely to suffer depression and have reduced social interactions. 

The National Institutes of Health published an article about why people lose friends after a stroke and why this phenomenon occurs across the board . 

Under the helm of the English study, Northcott and Hilari explored why people lose contact with their friends, and how friendship loss and change is perceived by the survivors.

Between 8 and 15 months post stroke, 29 participants were recruited, 10 having aphasia. The researchers deduced the main reasons given for losing friends were: 

1. loss of shared activities 
2. reduced energy levels
3. physical disability
4. aphasia
5. unhelpful responses of others
6. environmental barriers
7. changing social desires 

"Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke," says the study. 

"The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity-based, and where the participant had a 'friends-based' social network prior to the stroke."

Another study by Martinsen et al in a nursing journal examined psychosocial consequences following a stroke and the survivors’ ability to participate in and carry out the ordinary and expected roles and activities of family life. 

Twenty-two stroke survivors aged 20–61 years were interviewed extensively six months to nine years after stroke onset. The struggles are summarized in two main categories: struggling to reenter the family and screaming for acceptance.

"Being provided with opportunities to narrate their experiences to interested and qualified persons outside the home context might be helpful to prevent psychosocial problems," the study says.

Normality includes feeling sad over the problems caused by stroke. However, a portion of the survivors experience a major depressive disorder which should be diagnosed and treated as soon as possible. The people we should focus on are the people with a major depressive disorders which includes a number of symptoms nearly every day, all day, for at least 2 weeks. 

These always include at least one or more of the following, and all the time beyond 2 weeks:
  1.  Feeling sad, anxious, pessimistic, and/or hopeless 
  2.  Loss of interest in things that the person used to
       enjoy
  3.  Feeling restless, loss of energy, and/or feeling
       fatigued constantly
  4.  Feeling worthless and/or guilty
  5.  Increase or decrease in appetite or weight
  6.  Problems concentrating, remembering, and/or 
       making decisions
  7.  Trouble sleeping or sleeping too much
  8.  Headaches and/or stomach problems
  9.  Sexual problems 
10.  Thoughts of death or suicide

What are the takeaway thoughts? There are two. 

First, it is normal for a stroke survivor to experience most or all of these feelings or emotions. Second, family and friends should take heed and be more supportive of the survivor regardless of the healthy one's sometimes biased, small-minded, and me-centered thinking. 

A Stroke Survivor and an Uber Psychopath

My friend has a huge SUV, a BMW with a running board that, as a stroke survivor, on my very best day ever, I can't enter, to travel to and fro. So whenever she comes and I have an appointment, we take an Uber. Every Uber driver I met was pleasant, except one on that horrid day when I encountered a Uber psychopath. 

We were traveling to Adventist Hospital for a bi-weekly blood draw and everything was fine in the "to." But the "fro" was a different matter altogether.

When he stopped to pick us up at the hospital which was a 15 minute ride back to my apartment, my friend and I couldn't tell there was something wrong with him. He stopped, put the wheelchair in his trunk, and we were off. 

My friend asked him if he could possibly stop at  the pharmacy to pick up my prescription, and he agreed. At the pharmacy, once she got out of the car and entered the pharmacy, the questions started and I knew why he agreed to stop.

"Do you want to drive off and leave her here to make out later?" he chillingly said. "I know a place."

In the seconds that followed, I simply laughed, intentionally defusing those words as if he meant it as a joke. But his expression was dead-pan. 

He went on when I didn't answer him.

"We could drive far away from here or, if you'd rather, I could come in your apartment building to make sure you get safely to your apartment."

I laughed again to further defuse, but by now, his tone took on a more aggressive posture. I was on the brink of despair. I didn't look at him again, and I thought of opening the car door, but I didn't have my cane to walk away. It was in the trunk. I thought of getting out anyway and falling down (that was a given), but I might crack a rib or break my nose again or one of hundreds of other possibilities. How could I defend myself as a disabled person? I sat there with a smile on my face, but I felt chilled in the heat wave that was encompassing Portland, OR.

Fortunately, the pharmacy was not crowded and my friend came back out. He repeated the last question to her.

"I could come with you all to make sure you get safely to your apartment. Would you like me to park the car and do that?"

My friend, completely unaware of his thoughts leading up to that question, thanked him but said the building is a secure one so no need for him to bother. 

When we returned, he got the wheelchair and the cane out of his trunk. When he drove off, I told her what happened, and then she became horrified. We talked about calling the police, but then we decided to give him a "1" (you have to rate the Uber drivers) and not giving him a tip, all done by email shortly after the ride happens. We were going to call the police, but as time went on, I forgot the name of the driver and the encounter became less horrifying.

I've come to regret that decision, possibly allowing it to happen to other passengers, especially the disabled. I give myself virtual smacks on the head often. I also wonder if Uber vets the driver for mental health issues. I am an average-looking, 70 year old woman. If it could happen to me, being past the stage of "hotness," what about the others, younger and more attractive than me? 

I'm still wondering, with regret abounding forevermore.

I Was Naked In The Shower With A Man...And More

That title would be something that you'd see in a tabloid. But it happened to me. Before you get all hot and bothered, let me explain. It's not you're thinking.

It is hot here in Portland, OR, with heat advisories for the last two weeks, and my mind is always in thought. I think about my third book, not about strokes, but about relationships. I think about the coast this coming Monday where I can enjoy the mild sun, scrumptious food, and needless though necessary shopping. And I think about my time in the Bacharach award-winning acute rehabilitation facility where I had adventures as well, mostly all wretched. I want to forget about the acute rehab, but at least once a week, there it is, in my thoughts.

It's not that I want to think about it 9-1/2 years later, but it contributed to my Post Traumatic Stress Disorder (PTSD). Take the man in the shower, for starters.

The days seemed endless because they were waking me up at odd hours to take a blood draw, or changing my IV bag for hydration, or a Certified Nursing Assistant (CNA) complaining about the shift, and on the eighth day, the nurse came in and announced that I was going to take a shower. I couldn't talk for almost a month and a half, so I couldn't protest. Looking back much later, I hadn't showered for 32 days since I had the stroke on April 8, 2009. I guess I got sponge baths in the meantime. I don't know, and at the time, I didn't care.

The nurse maneuvered me out of bed and into the wheelchair where I would transfer to the shower chair, taking the IV bag in tow. (It was accompanying me everywhere I went and the shower was no different, the nurse positioning it in front of the shower's curtain). A male CNA was helping her with the transfer, and when I was positioned, she turned the water on. I heard her laugh with the CNA about how she didn't warm up the shower before I got in.

Let's pause here. Do you the iconic movie Psycho where Janet Leigh issues a blood-curdling scream? That incident, memorable to most, was rigged by the director, Alfred Hitchcock, who turned off the hot water as she shot the scene, unknown to Leigh. That scream I uttered was like the scream in Psycho, but worse because the cold water lasted longer.

Anyway, back to the story. I couldn't wash myself, wild-eyed and PTSD'd from having gone in the shower in the first place, not to mention the whole stroke experience thing (which not only devastated me but my sons as well.  Check out this post: https://stroketales.blogspot.com/2018/02/my-sons-my-sons.html)

But soon, fully clothed, the CNA got in the shower with me and spread soap everywhere, even my "down there" region, as my mother used to say.

He rinsed me off as best as he could accomplish, and the nurse turned the water off. But I still had soap in my "down there" place and between my toes. And I couldn't talk. It was a living nightmare because I knew that soap would make me itch. And it did, two hours later.

The nurse dried me off and the CNA, dripping wet and assisting the nurse who got me back in the wheelchair, went to torment another patient, I thought.

I'll never forget her words as she breezed out of the room.

"Don't you feel better," said as a statement instead of a question.

"I feel like shit," I screamed silently, but the one thing I didn't have anymore was modesty. I fell asleep, wondering if I could change my profession to a stripper from a college professor because modesty had become a non-issue. That thought alone was deranged, but I didn't realize it at the time.

Breaking (albeit 9-1/2 years old) news: Bacharach didn't deserve that award. Protocol couldn't have been to send the opposite sex in the shower with the patient. And, oh yeah, I had become a delusional mess.

Quirky Personality of the Stroke Survivor: Caregivers Are the Most Important Part

C’mon. You must know a stroke survivor, with 800,000 getting strokes annually, and that number is just for the United States alone! At the very simplest common denominator, this post is for:
* Stroke survivors trying to figure out why they're different from before
* Families/friends trying to understand the stroke survivors' change
* Caregivers who act as a bridge, aka lynchpin, between survivors and families/friends

First, some background. Scientific American's Jon Stone, a consultant neurologist, writes, "Friends and relatives may report a personality change that is hard to pin down. Some of these changes, such as low mood and anxiety, are more likely to be related to a person's feelings about having a stroke than to any harm to the brain." 

But he contradicts by saying (I am the critic, too), "A genuine shift may occur, however, when the frontal lobes sustain damage. The frontal lobes play an essential role in regulating emotion, decision making, and judgment." 

"A stroke that hits the cerebellum," he continues, "can also trigger a personality shift. This brain region is vital to many aspects of executive function. Damage here can bring about disinhibition, which often manifests as inappropriate behavior. Other 'negative' personality changes include poor decision making, aggression, and irritability."

He also says less common are cases of “positive” personality changes, in which people reportedly become happier and even nicer. (I became more compassionate and less judgmental).

The Stroke Foundation of Australia lists changes in personality including inability to do anything, being irritable or aggressive, saying or doing things that seem inappropriate to others, and acting without thinking, and doing things that are not safe or are not appropriate. 

(In my book, The Tales of a Stroke Patient, I escaped from the sub-acute facility, and lived to tell about it, in search of soft-serve ice cream, ignoring safety concerns like traffic and mixed-up directions. Poor decision, right?)

In an article "The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work," written by Reg Morris and published by the venerable National Institutes of Health, the study is recounted that young stroke survivors have more practical and physical needs than old survivors. 

Stroke survivors under 50 years of age were studied, and found that family conflict and loss of home, employment, and spousal dissension were common practical problems. 

In summary: 

Employment loss was rated 80%–90%.

About half of survivors had psychological disorders, mostly depression or anxiety about work, recovery, and childcare.

A quarter to a third exhibited denial, anger, frustration, or hostility.

A majority expressed problems with employment, finances, social participation, and/or sexual problems.

Frustration was a main theme found in survivors under 55 years old, for up to two years after a first stroke. 

The frustration was related to fatigue that affected everyday activities and gender roles. 

Invisibility and "outside the loop" centered around lack of information and consideration of young survivors, a shortage of activities for the younger survivors, and the awareness of their apparent cognitive and yet "invisible" impairments. 

The austere Cleveland Clinic says the loss of a person’s former identity can result in depression, anger, and frustration which calls the grieving process, denial, anger, bargaining, depression, and acceptance, into play.

Some stroke survivors have difficulty with their communication skills following a stroke. They can be categorized in two general areas.

The first is speech disorders, says the Cleveland Clinic, and the second is aphasia, "the loss of ability to communicate normally resulting from damage typically to the left side of the brain, which houses the communication center." It may affect a person’s verbal expression, auditory comprehension, and the person's ability to read, write, and manage numbers.

"Some stroke survivors may have slurred or garbled speech as a result of muscle weakness or incoordination (called dysarthria) or motor programming of speech muscles (called apraxia)."

A Speech-Language Pathologist (SLP) will be on the scene to evaluate the patient’s communication skills and show ways in which the family can help. The SLP will also recommend any follow-up after the survivor is released from the hospital. 

And finally, the most important part in this post. The American Heart Association journal, a study was published and it was named "A Quantitative Study of the Emotional Outcome of People Caring for Stroke Survivors," i.e. caregivers.

In a randomized trial, the patients and caregivers were asked to complete 2 measures of emotional distress. A "regression analysis" was used to name the factors that were associated with poor caregiver outcomes.

Fifty-five percent of responding caregivers indicated that emotional distress is common. Caregivers were more likely to be depressed if the patients were severely dependent.

The study's main goal was to help to identify those caregivers at greatest risk of poor outcomes. 

I could have told you that. Hands down, every profession from street cleaners to neurosurgeons have people in those occupations that shouldn't be there. Yes, caregivers, too. You know someone who shouldn't be what they are if you really think about it. 

When it comes to caregivers, they are the most important of all. They are the lynchpin to find the common ground on which the survivors' antics, if you will, are understood by family and friends. 

It's all up to you, caregivers, because things happen fast in the world of stroke and other brain injuries, leaving the family and friends who come to see them, too soon in most cases,  bewildered and angry, and often times there is no source for that confusion and disarray.  It just happens. You can't blame the stroke survivor, yet many of them do.

So if you're a caregiver, DO YOUR JOB, and that means going the extra mile beyond bathing the poor soul and cooking the meals that aren't high on the priority list. Try to make sense, to the families and friends, of the stroke survivor's behavior. Or any brain-injured person, for that matter.

Otherwise, as I've said to the caregiver, more times than I'd like to count, "Get the hell out!"

PRP: Give a Little Blood, Get Some Amazing Results, Even With Hair Loss

Here's a question for you. What do Lakers Lonzo Ball (knee injury), golf's gift to women (only kidding) Tiger Woods (torn Achilles' tendon), and Brewers pitcher Chris Capuano (strained quadriceps) have in common? The answer is, they are professional athletes who all had PRP. In our over "acronym-ed" world, the term stands for Platelet-Rich Plasma. 

Sometimes it works, sometimes it doesn't. However, when it comes down to a possible career-ending choice, it's sometimes the right choice, born of desperation and hope. 

PRP, for ordinary folks like you or me, comes down to QOL (quality of life) issues, and that's just as important. 

PRP therapy is a nonsurgical treatment for individuals suffering from chronic tendon injury or osteoarthritis, for example. PRP treatment utilizes the patient's own blood to source platelets, which are then injected into the bothersome  area. In addition to pain relief with no surgery, PRP speeds up the healing process. The procedure takes less than an hour, and most patients return to pre-injury status within three months.

A single PRP injection costs $800, while additional injections in the same area cost $600 each, as of 2015. The cost of platelet-rich plasma treatment varies based on the amount of treatment administered, states Emory Healthcare.

OrthoInfo, a website published by the American Academy of Orthopaedic Surgeons (AAOS), says it may be beneficial for chronic tendon injuries, acute ligament and muscle injuries, surgery and fractures to make recovery faster, and knee arthritis. The AAOS also says the following: "There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections."

What you probably haven't heard of is that there's a similar treatment for hair loss, and yes, it requires your blood.

It's called platelet-rich plasma, too, says Joshua Zeichner  the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. 

"Our blood is made of two main components, red blood cells, and plasma," he says. "The plasma contains white blood cells and platelets, which are rich in growth factors."

Beginning with a standard blood draw from the patient's arm, there is a careful process involved in using PRP for hair regrowth. 

Zeichner says, "The tube of blood is put into a machine called a centrifuge, which spins the blood tube to separate out the red blood cells from the plasma. The plasma, rich in platelets, is then injected directly into the scalp at the level of the hair follicles." [Ouch!]

The process is precise with injections beginning across the scalp, approximately at every half inch over the area of thinning hair. The procedure takes less than a half hour. There's no documented risk associated with PRP. 

"Most patients get injections without any numbing, as there is minimal discomfort," says Zeichner. "However, cool air or ice packs may be used to minimize pain." In the event there is any after-procedure pain, Zeichner recommends Tylenol. Bruising can occur but usually is resolved within a week or two.

Zeichner adds, "I personally recommend a warm shower, as the hot temperature will enhance blood flow and circulation throughout the scalp. PRP is best used for patients with androgenic alopecia, which is a genetically determined type of hair thinning that typically occurs along the top of the head." 

Treatments are typically performed once a month for the first three to four months, and then every three to six months, depending on the patient's response and results. 

"The first result that patients usually note is decreased hair shedding, followed by early regrowth and increased length of hair," says Dr. Neil Sadick, a dermatologist in New York City. He illustrates:



"The general consensus is that receiving treatments every three to six months on a long-term basis are optimal for continuing to stimulate the growth factors and stem cells that are associated with regrowth and stopping hair fallout," says Sadick.

Maybe I'll look into PRP for my re-fractured rib and my poor posture affecting my spine from my stroke. Desperation, hope, and quality of life. There they are! Just like I said!

When Is Enough Exercise Enough?

[This post is to all chronically-ill people, their caregivers (or personal assistants as I call them), their family, people who suspect a chronically disease eventually because it runs in the family, and that equals a lot of folks.]

I came across this statistic: By 2030, as many as 11 million people could be living with stroke as more people live longer. Yikes. Research time.  

The title from Flint Rehab: More Is Better… Except When It’s Not, caught my eye. 

Flint Rehab says, "While repetition [of exercise] is important, too much exercise can start to hinder your progress. [Uh huh.] You need a good amount of rest and sleep in order to successfully recover."  

Something, but still nothing that answers my question specifically.  

And it got me thinking, because most times for me, it's never enough. Then when I hurt badly, aka when enough is more than enough, I turned to guilt because for several days, I rested my weary bones. One step forward, one step back, kind of thing. No progress at times. None at all.

When I achieved rest, and dreaded naps, it messed up my sleep, aka circadian rythyms. Then I couldn't go to bed before 3am. That's 3am on a good night. Now, I don't take any naps. And yes, I am tired, but it's a trade-off. I want to have good results with my exercise instead of giving in to my fatigue.

Now, I set the alarm on my cell for 15 minutes no later that 1pm. The power nap routine! That's just enough rest to re-fire my engine and sleep, aka nap, or not fall asleep. With my  eyes closed, it's still rest.

But I digress. This post is not about circadian rhythms, let alone mine. It's about exercise, specifically, "Am I doing enough exercise and how do I know when I reach that point of, it's enough?"

The Stroke Foundation across the other pond, aka Australia, says the repetition is the main focus on improvement. 

"Regular activity will help you to continue your recovery. Exercise improves your fitness, your general health, and reduces your risk of having another stroke." 

That means not when you feel like doing it but doing it every day. But nothing in that article addresses "when is enough exercise enough." I plowed on.

Then I came across this: Exercise is a valuable yet underused component for post-stroke care, according to an American Heart Association/American Stroke Association scientific statement. [Hmm. Now we're getting somewhere.]

"There is strong evidence that physical activity and exercise after stroke can improve cardiovascular fitness, walking ability, and upper arm strength," said Sandra A. Billinger, P.T., Ph.D., lead author and a physical therapist at the University of Kansas Medical Center in Kansas City, KS.

[Read more, I said.] 

"Yet, too few healthcare professionals prescribe exercise as a form of therapy for stroke. There is a big gap in America once stroke patients are discharged from rehabilitation and the transition to community exercise programs when they go home. Many are left on their own. [I was.] We don't have a system in place to help stroke patients feel comfortable with exercise.

And here it was:

"The general recommendation," says Billinger, "is that survivors exercise at least three days a week for 20 to 60 minutes, but that depends on their individual functional capacity. For many stroke survivors, multiple 10- to 15- minute bouts of moderate-intensity exercise may be better tolerated.

Aah. Hard data. At last. I was striving to do the exercise every day. It was too much, the good doctor implied. Every day. Core strengthening, 15 reps, 3 sets, the same with marching and leg stretches and Thera-band leg pulls and lifting my legs outward and behind me while holding on to the countertop, one leg at a time, and walking the halls for 500 feet, and weights, left hand only. 

Now I alternate with walking the halls and weights, and the other stuff aforementioned. I just started last week but no pain. I feel the good hurt. Life is good at the moment. I have the feeling that I found the key.

But Stroke is an ongoing mystery to find the other keys. Always a key. 

10 Things You Probably Didn't Know About Brain Bleeds

It's quiz time! 

If a hemorrhagic stroke could happen to me, with both low cholesterol and blood pressure, no diabetes, and a non-smoker, it could happen to anyone. Or is it an aneurysm? Now I know! And even more.

Here's 10 questions about brain bleeds. Write down your answers and compare them with the real answers below. Let me know how you did. 100%? In your dreams! (But maybe). Good luck.


1. Is a hemorrhagic stroke the same thing as an aneurysm?

a. Yes, they're the same

b. No, but a hemorrhagic stroke is one of the most usual kinds of a ruptured aneurysm

c. No, but a ruptured aneurysm is one of the most usual  kinds of a hemorrhagic stroke


2. A cerebral aneurysm is

a. a thin or weak spot that can occur on a blood vessel of the brain

b. random with no known cause

c. a thick spot that can occur on a vein in the brain


3. A hemorrhage stroke

a. is not emergent and which requires immediate bed rest at home

b. is a medical emergency that requires immediate treatment

c. is a medical emergency that always requires an operation


4. A hemorrhagic stroke

a. is more common in women than men

b. is more common in men than women

c. splits 50-50 among genders


5. Symptoms of a hemorrhagic stroke usually occur 

a. when the person is awake

b. when the person is asleep

c. both a and b


6. Most brain aneurysms

a. don't rupture

b. don't create health problems or cause symptoms

c. both a and b


7. Although aneurysms can appear anywhere in the brain, they are most common in arteries

a. at the top of the brain

b. at the base of the brain

c. anywhere in the brain

8. Go to the hospital immediately if

a. you have a mild headache

b. you have the worst headache ever

c. if you have insurance

9. Among the first blood tests in the event of an ruptured aneurysm is to determine

a. your ability to clot

b. your stress level

c. your cholesterol 

10. Usually, hospitalization is followed by a period of living in a rehabilitation center, where additional intensive stroke therapy may be provided

a. to assist the patient with financial responsibilities

b. to help the patient recover as much physical and speaking function as possible

c. to make the patient aware of all the negatives

Answers: 1. c , 2. a, 3. b, 4. a, 5. a, 6. c (a brain aneurysm that doesn't rupture is often detected during tests for other conditions), 7. b, 8, b (whether you have health insurance or not, the hospital has to treat you, but you may wind up with a huge bill if you don't have health insurance), 9. a, 10. b