2021-10-07

Stroke in Antarctica in a Novel


 

(If you don't see the audio player above, visit http://Strokecast.com/Antarctica)

I don't see many novels that deal with stroke and aphasia. Memoirs, sure, but not novels. That's one of the things that makes Jon McGregor's novel, Lean Fall Stand,* interesting. That, pls the fact that Jon himself is not a stroke survivor. He's someone who has taken an interest in our community an endeavored to learn more.

Oatmeal, a light-brown Jellycat brand teddy bear, sits on a couch and read's Jon McGregor's Lean Fall Stand

Jon's novel follows the story of Robert, a research scientist in Antarctica. Robert gets caught in a storm , suffers a stroke, and acquires aphasia. The novel chronicles Robert and his wife's adventures as they enter and then adjust to living in stroke world.

Jon and I talk about the book, Jon's research, his adventure in Antarctica, writing beyond an author's personal experience, and more.

About Jon McGregor

Author Jon McGregor wears a dark patterned shirt, suspenders, and a beret while standing against a dark green wall looking at the camera

Jon McGregor is the winner of the International IMPAC Dublin Literary Award, the Costa Book Award, the Betty Trask Prize, the Somerset Maugham Award, and the American Academy of Arts and Letters E. M. Forster Award, and has been long-listed three times for the Man Booker Prize, most recently for his novel, Reservoir 13. His latest novel, Lean Fall Stand*, is out from Catapult in September 2021. He is professor of creative writing at the University of Nottingham, England, where he edits The Letters Page, a literary journal in letters.

Jon's Resources

Jon talks a lot about the research he did to understand the experience of stroke and aphasia. He met with therapists. He talked with survivors. He attended support groups.

The Stroke Stories podcast is another resource he used to learn about Aphasia and stroke from a survivor's perspective. It's a show that tells stories more as news type pieces rather than in a traditional podcast interview. You can find it in popular podcast apps.

A couple years ago, I was lucky enough to be a guest on the show. You can listen to that episode here: Stroke Stories Episode 50 - Bill Monroe

The Aphasia Access Conversations podcast is another one Jon found helpful. It's a show focusing on the education, experience, and thoughts of speech therapists who work with folks who have aphasia.

For more stroke related podcasts, visit http://Strokecast.com/StrokeRelatedPodcasts.

Jon also learned from Sara Scott's YouTube channel. Sarah survived a stroke at age 18, about 12 years ago. Since then she has posted videos recognizing various strokeaversaries. You can watch her progress in dealing with aphasia over the decade and see her recovery over the years.

Sarah Scott 10 years living with Aphasia

(If you don't see the embedded video, visit http://Strokecast.com/Antarctica)

Edwyn Collins is a Scottish musician who made it onto the worldwide charts in the 80s with his post-punk band Orange Juice. He survived a stroke with aphasia in 2005. Jon drew inspiration from the documentary of Edwyn's story, "The Possibilities are Endless"

The Possibilities Are Endless (Official Trailer)

(If you don't see the embedded video, visit http://Strokecast.com/Antarctica)

Jon also learned from the Stroke Odyssey production from Rosetta life:

SO Trailer 7

(If you don't see the embedded video, visit http://Strokecast.com/Antarctica)

Artists' Residencies

Artist residencies are a fascinating thing. In the one Jon talked about, he applied to go to Antarctica. He would be provided transportation, lodging, and access to the work of research scientists. In return, he would, eventually, make a thing.

In Seattle a couple years ago, the city offered space in a draw bridge that an artist could have for months to make a thing inspired by the space.

The variety of residencies available to artists is kind of amazing. It's an interesting intersection of public relations, marketing, public art, patronage, and other elements.

If you feel a desire to create but want space, education, or inspiration, it may be worth exploring the idea of residencies.

Writing About Marginalized Communities

We discussed the idea of writing about marginalized communities in this interview, specifically about disabled people or people with disabilities.
 

A lot of the same concerns apply when writing about folks of a different race, gender identity, sexual orientation, religion, cultural background, etc.

When you write a character who is of a different group, especially if the character is part of a historically marginalized group, the writer has a special obligation to get it right -- to make sure they can write about the character and the character's experiences with honesty, accuracy, and individuality, without reducing them to a series of stereo types.

I've read parts of Lean Fall Stand* (Jon's team sent me a copy) and so far, his portrayal seems good. Of course, my experience with aphasia is all second hand. I'd encourage you to check it out and share your thoughts.

Become a better writer

Jon is a long time novelist and a professor of creative writing. You might expect him to have advanced models and techniques for becoming a better writer and telling better stories. But what is Jon's advice?

Read more.

Write more.

It's that simple. Sure you need to read deliberately and think about the choices a writer makes in the pieces you read.

To get better at walking, we need to walk more. To get better at moving our fingers we have to move our fingers more. To get better at speaking, we have to speak more.

To get better at writing, we have to write more.

More reading and more writing. Hmm. I can get behind that.

Hack of the Week

Jon talked with as bunch of folks with aphasia and cited two things they did that were helpful.

First, the used their phones and tablets to help communicate. It wasn't just about typing out messages or using special apps, though. It was about using other tools for communication. For example, telling the story of travelling to a city by using the maps app. It was about thinking of different ways to share the story without strictly telling the story.

Second, a lot of the folks Jon spoke with carried a card that explained they have aphasia and explains what aphasia is. There are still millions of people out in the world who have never heard of aphasia and folks with aphasia still have to deal with them. A simple card can make a big difference.

Links

(If you don't see the list of links below, try visiting http://Strokecast.com/Antarctica)

Where do we go from here?


Here is the latest episode of The Strokecast

2021-09-27

London Cop and Stroke Survivor Becomes a Fantasy Author


 

James Horton was a young police officer in London. He was 27 and felt invincible. His partner (personal one, not police one) was about to give birth to their first child. Naturally, that's the time a life of high blood pressure caught up with him and he experienced a hemorrhagic stroke.

In this week's conversation, we James and I talk about that experience, how policing in London compares to policing in the US, how his stroke impacted his life and career, and how he came to write his fantasy novels in the Blue Swords series.*

You can listen to our conversation in the player above or in your favorite podcast app. If you don't see the player, visit the full article at http://Strokecast.com/JamesHorton.

About James

Headshot of stroke survivor, fantasy author, and London police officer James Horton. James smiles facing the camera in front of a white backdrop

From James' Amazon Author page:

James Horton left his hometown in rural Lincolnshire to join the police service in London at the age of nineteen. Serving as a police officer in several units, James has had his eyes opened to the highs and lows that comes with serving as a constable.

Suffering a stroke at the age of twenty-seven, James turned to historic action novels to help settle his mind and aid his recovery.

After his recovery, James decided to start writing his own novel, combining a career in the police and his passion of medieval stories. His first book, BLUE SWORDS, the first of The Crimes and Crests Saga has been based on true events, merged with a historic twist.

Author profits for Blue Swords, books 1&2* will be donated to the Stroke Association UK.

James would love to hear from his readers and can be contacted via his author page.

High Blood Pressure

High Blood Pressure is a major cause of stroke. It caused James' stroke. It caused my stroke. It caused the stroke of many of my guests. It's easy to check because home blood pressure monitors are pretty cheap.

Many people don't check, though. And many never know they even have high blood pressure until it's too late.

And that's because it doesn't hurt.

Generally, high blood pressure causes no pain or outward symptoms while it's slowly destroying our blood vessels, as surely as the surging Colorado River destroyed the rocks in the Arizona dessert to carve the Grand Canyon. That's a beautiful thing to look at in the ground. It's not so beautiful when it's happening in our bodies.

I only found out about mine when I started getting massive nose bleeds at random. By that point, the damage that would lead to my stroke had already been done.

The American Heart Association recommends we work to keep our blood pressure below 120/80 (I'm currently right there - YAY!)

I spoke about how it causes damage in much greater detail with Dr. Nirav H. Shah in episode 47.

You can listen to that episode here:

(If you don't see the player, visit http://Strokecast.com/JamesHorton)

Here are 3 blood Pressure Monitors available on Amazon. Really, there are dozens or hundreds of options. I have no experience with these three directly, but they're a good place to start your shopping.

HoMedics Automatic Blood Pressure Monitor, Wrist*

Blood Pressure Monitor Upper Arm, Mebak Automatic Digital BP Machine Cuffs for Home Use*

OMRON Silver Blood Pressure Monitor, Upper Arm Cuff*

Chart from heart.org showing levels of hypertension

Johnny Cash -- Hurt

James talked about his experience listening to Johnny Cash's Hurt.

(If you don't see the video, http://Strokecast.com/JamesHorton)

https://youtu.be/8AHCfZTRGiI

Stroke Recovery Time Frame

There are still doctors and others who will tell a stroke survivor they have 6 months or 12 months of recovery and what they have at that point is all they'll ever get back James doctor told him he had just 12 weeks to recover.

This is NONSENSE.

As long as you live, you can still recover and regain function. Even years down the road survivors continue to recover. At four years post-stroke, I'm still getting finger control back.

Recovery will be fastest in the early days, sure, but it continues to be possible with hard work for years and decades after stroke.

Don't let anyone put an artificial cap on your recovery.

Hack of the Week

James talked about two things that help him with anxiety and depression.

First, get exercise. Even if it's just a little bot. Get some exercise. Get moving as best you can. It helps with health, but more importantly it helps with clearing your head.

Secondly, and in an oddly related way, is to try writing. That could be by hand, by keyboard, by voice, whatever. Writing is a powerful tool for not only enhancing your communication but also for helping you get stuff out of your head and calm your mind.

So take a few minutes to exercise your body and to exercise your pen.

Links

(If you don't see any links, click here.)

Where do we go from here?


Here is the latest episode of The Strokecast

2021-09-12

Stroke Leaves a Woman "Trapped Within"


 

Jo Ann Glim and her husband were enjoying the semi-retired lifestyle in their new, Florida home. They enjoyed day trips, volunteer activities, and other adventures. Jo Ann was starting a new temp gig at the Tropicana offices, and they were making all sorts of plans for the coming years

.A blood vessel deep in Jo Ann's brain had other plans. It ruptured and damaged her Thalamus on her first day at a new temp job.

Jo Ann would spend two weeks basically unconscious. With lots of work, determination, a a great team, she dove into her recovery.

Twenty four years later, she joins us to talk about her journey, her writing, the risks of being a problem solver, and the things that helped along the way.

Her book, Trapped Within: A True Story of Survival, Recovery, Love, and Hope* is available on Amazon.

About Jo Ann Glim

Jo Ann Glim sits in front of a dark background looking at the camera. She wears a black dress with white polka dots. She wears dark rimmed glasses

Jo Ann Glim was born in Chicago, Illinois to a military family and raised in Anacortes, Washington in the far reaches of the Pacific Northwest in a three-generational household. Even though the family was poor, she never knew it.  Poverty taught her life skills: self-sufficiency, creativity, and saving for a rainy day. Her childhood home was filled with love. Tragedy struck when she was fourteen and her mother passed away. Within three weeks, her grandparents were relocated to a nursing home in Illinois and she was taken in by her mother's sister. Everything she had known to be home was gone.

​After she finished school, Glim's career followed three paths: MEDIA - (as a disc jockey/copywriter) WSDM-FM Chicago, KMPX-FM San Francisco, and KIKI-AM Hawaii; and continued in COMMUNICATIONS - a forty-year freelance portfolio with credits including an award-winning column in fourteen northern Illinois newspapers; one-liners for nationally known comedians; monthly articles for Manatee County Florida's Chamber of Commerce Current magazine, to name a few. She took courses in BUSINESS MANAGEMENT - at a local college and after moving to the suburbs, began working for Kelly Services. Sixteen years later, she retired as an on-site Human Resources Manager responsible for the temporary needs of a Fortune 500 company. ​

She now lives in Florida with her husband, Bill, and their Scottish Terrier, Lucy. Her passions are writing, photography, and travel. She loves Chicago pizza, and is happiest travelling with her hubby, playing handbells, or on hiking trails with her camera and dog.

Book

Jo Ann sent me a copy of her book before we talked.  The book, Trapped Within: A True Story of Survival, Recovery, Love, and Hope*, chronicles her stroke and rehab experience. She gets deeper into her relationships with doctors, therapists, and her therapy roommate and shares fears, frustrations, and lessons learned along the way.

Jo Ann writes with a crisp style that's easy to read. Her chapters are short. If you can read only a few pages without a nap, it's a nice choice. Or you can just read chunks of  it at one go.

You can find Trapped Within on Amazon in paper or eBook versions.

Check it out at http://Strokecast.com/TrapedWithin*

"Trapped Within": Book Trailer



Elizabeth Kubler-Ross and the 5 Stages of Grief

Kubler-Ross wrote about grieving and death.  Recovering from stroke is similar, except instead of grieving over the loss of another person, we are grieving for the loss of our prior selves. Getting through that process takes time, but it also helps us adapt to the new life we have after stroke.

The 5 stages of grief are:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance.

If you're struggling with moving on with your life a neuropsychologist or other counselor can help you navigate this path.

Hack of the Week

Lainie Ishbia from Trend-Able, who I spoke with in Episode 136 suggests that if you struggle with fastening buttons on a shirt, you can get around that.

Just sew (or have someone else sew) the shirt closed at the buttons and turn it into a pull over. That way, you can still wear those stylish button down shirts without spending hours dealing with fussy closures single-handedly.

Another option for those shirts, if you're not ready to get them sewn up, is to get a button puller*. This is an inexpensive device that makes it easier to fasten buttons with one hand. I use mine most when I'm trying to put my dress shirts on a hanger.

Either way, you now have 2 fewer reasons to not wear that nice shirt.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-09-02

From Locked in to Pageant Queen


 

At 30 years old, social worker Jeri Ward was incredibly busy. Perhaps too busy. Having a stroke was the not even on her radar. But then again, is it ever?

Multiple hospital visits and a failed thrombectomy later, she found herself completely paralyzed and unable to speak for months in a hospital bed. Scared, bored, and frustrated she would go on to recover, win the title of Mrs. Ohio International, and partner with the American Heart Association to raise awareness of stroke in the general population.

Jeri spoke to me for over an hour in the days leading up to the Mrs. International.

About Jeri Ward

Jeri Ward wears a gray blazer in a white/off white room near as window. She has long, brown hair.

Jeri Ward lives and works in Ohio. She built a busy career as a social worker, Autism specialist, and volunteer. Jeri was always on the go, with one project after another.

In the midst of that hectic schedule she nourished her passion of pageant life and lived it for decades. In 2018, Jeri was crowned Mrs. Ohio America.

Later that year, Jeri barely survived a massive ischemic stroke. She was locked inside her own body in an ICU bed for months. Gradually, she recovered her speech and movement. And she rededicated herself to the cause of stroke awareness and advocacy.

In 2021, Jeri returned to pageant life, winning the title of Mrs. Ohio International with a new platform of raising stroke awareness and advocating for survivors both at home and around the world.

She started the Lemonade Project to help folks learn and practice appropriate self-care.

Jeri currently works at the American Heart Association as a Development Director.

Mrs. International Pageant

A  lot of folks have preconceived notions about pageant winners, and often those notions are not true. Jeri is the fourth pageant winner I've had the pleasure meeting. Marsha Scmid was a guest on the show a couple years back after winning the title of Ms. Wheelchair USA. It was a stroke caused by a chiropractor that her eligible for that pageant.

Ina previous job, I had the pleasure of working with Hilary Billings, a former Miss Nevada. I interviewed Hilary for my other podcast, 2-Minute Talk Tips. You can hear that conversation here.

And I went to college with a woman who would go on to become Miss Montana. They have all been some of the smartest, hardest working people I know. Really incredible individuals.

The Mrs. International pageant, as Jeri describes it, puts a premium on contestants' platforms, a I don't mean their shoes.

This was a great match for Jeri who has turned her stroke into a cause -- to take every opportunity she can to help with stroke education and advocate for survivors.

Jeri did an amazing job at the finals, coming in in third place. She chronicled her journey on Instagram

Ohio Legislation

Jeri channeled her career experience, her stroke advocacy work, and the drive she uses in pageant life to help the Ohio State legislature pass SB21, which updates protocols for EMS. The short version is that this law will require ambulances to take stroke patients to an appropriate hospital, rather than the closest hospital.

As we know, time lost is brain lost, and moving folks from hospital to hospital costs time, money, and long-term disability

This legislation will help change that in Ohio.

Hack of the week

Explain things to people simply. Jeri talks about the headphones she wears due to her sensory processing challenges. She'll mention briefly why she wears them in meetings at work.

Disclosing and talking about disabilities is a challenging subject. Outside of our doctors, no one is entitled to know our medical history. Even then, there are limits. There are lots of very good reasons for minimizing disclosure given how wide-spread ableism is in this world.

At the same time, there's something to be said for acknowledging the elephant in the room. The elephant is metaphor in this case. Imagine you are having a conversation with a few people at somebody's home. You are not circus or zoo folks. Then an elephant walks into the room and just sits there. And no one says anything. How can anyone focus on the main thrust of the conversation?

A fraking elephant just walked into the room!

In order for conversation to continue, someone needs to say something about the elephant. Pretending it's not there isn't going to work. Once the owner/roommate of the elephant says, "Oh, that's just Bob. He's cool. So, anyway…"

You may still have a lot of questions about Bob, but you can put those aside from now and get back to a productive conversation.

When folks mention "the elephant in the room," they are talking about something that is big, unexpected, and that folks might want to ignore, but can't. Acknowledging the elephant lets us get back on track.

Sometimes, all we need to do is acknowledge our elephants.

When Jeri puts in her earphones in a business meeting, is that an elephant worth acknowledging? Often, yes. Should it be? Probably not.

But someone who isn't familiar with sensory processing challenges may be speaking, see someone put on headphones and assume they are being blatantly rude and ignoring them in an aggressive manner.

By telling people what you need, such as when Jeri mentions why she uses them without going into detail, it lets the meeting get back on track without someone taking offense.

On another note, this is why it's important, if you're comfortable doing so, to share your story. To normalize disability and the tools we use to make our world more accessible. Canes and headphones and rollators and splints and service dogs may be elephants today, but they don't have to be in the future.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-08-23

Brain Remapping After Stroke


 

After a stroke, do nearby nerve cells take over the function of dead nerve cells as folks regain function? That's what we would expect, but new research from Dr. William Zeiger suggests that is not the case. After giving very specific strokes to mice, they used advanced imaging techniques to understand just what was happening in those little mouse brains. It was not what they expected.

We talk about that research, brain remapping after stroke, the importance of constraint induced therapy, and more in this episode.

Bio

Dr. William Zeiger professional head shot. He wears a white doctor's coat against a gray background as he looks at the camera

Dr. Zeiger is a physician scientist in the Department of Neurology at UCLA. Clinically, Dr. Zeiger works as a neurologist specializing in movement disorders, particularly Parkinson disease and atypical parkinsonian disorders. Dr. Zeiger also runs a neuroscience research lab focused on investigating cortical circuit dysfunction in neurological disorders.

The Study

You can read the paper Dr. Zeiger and his team produced here: https://www.nature.com/articles/s41467-021-24211-8

You can read an article about the study here. It's how I learned about the research and is a little more accessible: https://www.eurekalert.org/pub_releases/2021-06/uoc--hbc062521.php

Basically, researchers gave mice strokes in a specific part of the brain to stop a single whisker from working. They use a technology called 2-Photon Microscopy to examine the brains of these mice. They wanted to see if other nerves would simple take on responsibility for that whisker. That did not happen.

Then they removed all the other whiskers from the mice. Once they did that, mice began recovering function in that remaining, stroke affected whisker. Essentially, it was a form on Constraint Induced Therapy for the mice.

This gives us some interesting information about neuroplasticity. It's hard to extrapolate to humans, but it does point toward the needs for ongoing research into just what is happening during brain recovery.

The Neuro Nerds

The Neuro Nerds is one of my favorite podcasts. Host Joe Borges was a guest on this show back in episode 65.

This week, I was Joe's guest on The Neuro Nerds. We talked stroke stories, nerd stuff, Doctor Who, podcasting, the brain injury community, and much more. You can listen in your favorite podcast app or right here by pressing play.

Hack of the Week

One of the biggest risks for stroke survivors and Parkinson's Disease patients is falls. Falling is of course even more likely at night because it's dark and we're tired. And many of those late night falls happen during late night trips to the bathroom.

If you're a fall risk, one solution is a bedside commode or a urinal jug (sorry that doesn't help you, ladies). It may not be pretty or something you want in your bedroom, but if it means you don't fall and pick up another brain injury or other injury, it's probably worth it.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-08-10

Can you treat depression with Tai Chi?


Recent research shows that doing Tai Chi after a stroke may reduce depression. We talk with the author of the study in this episode.

It's a nice complement to our previous episode where we talked about the nature of Post Stroke Depression. Depression is an insidious illness that undermines recovery, healing, relationships and the joy we could find in life.

Traditional treatments may include talk therapy and/or medication. There are also a host of new treatments being studied. And there's a bunch of snake oil or scam treatments out there, too. Plus there's a whole bunch of stuff in between.

Dr. Ruth Taylor-Piliae has been working in the stroke field and with Tai Chi for a long time. Her research is a promising starting point for exploring the potential of ancient Tai Chi practices to treat Post Stroke Depression.

Bio

From the University of Arizona College of Nursing

Dr. Ruth Taylor-Piliae poses for a headshot in front of a golden brown backdrop

Dr. Ruth Taylor-Piliae is an Associate Professor in the College of Nursing at the University of Arizona. The goal of her research is to increase physical activity among older adults with heart disease and stroke through the implementation of innovative interventions such as Tai Chi, to improve physical functioning, reduce fall rates and improve quality of life.

Dr. Taylor-Piliae received her B.S.N. from California State University Fresno, her M.N. from the Chinese University of Hong Kong, and her Ph.D. from the University of California San Francisco. She completed a 2-year post-doctoral fellowship in cardiovascular epidemiology and prevention at Stanford University. Dr. Taylor-Piliae has received funding as a principal investigator from the American Heart Association/American Stroke Association, Hospital Authority of Hong Kong, National Institute of Health, and the Robert Wood Johnson Foundation.

She reviews for professional journals and has had over 70 peer-reviewed manuscripts published in top-tiered journals both within nursing and inter-professional journals. She is highly cited for her work (citations>3600, h-index=30, i10-index=54).

For more details, see https://www.nursing.arizona.edu/rpiliae

Should you do Tai Chi?

Maybe. Ask your doctor.

Before engaging in any new exercise program or treatment, ask your doctor to make sure you can do it safely.

I am not a doctor. I say it all the time. I'm just a marketing guy who knows way more about neurology and neuroplasticity than any marketing should know.

That said, let's run Tai Chi through my snake oil filter.

Is Tai Chi safe?

For the most part, yes. Of course if you have balance or movement challenges, an adaptive for may be more appropriate. Take steps to make sure you don't fall. Falling is probably the biggest risk, but it should be an easy one to mitigate,

Is it expensive?

Generally, it's probably not that costly. It's not going to cost you tens of thousands of dollars. With some searching, you can find free or low cost options.

Will it interfere with traditional therapies?

It doesn't have to. If you have the time and energy, you can do Tai Chi in addition to PT, OT, Speech, or Mental Health therapy. If you decide to do Tai Chi as part of your recovery, this random guy on the internet suggests to do it in addition to, rather than instead of regular therapy.

Will it actually help your recovery?

Maybe. As Ruth and I discussed, her research shows it does reduce Post Stroke Depression. Granted, it's a small study.

There are a lot of things survivors are encouraged to do to help recovery. Move. Exercise. Practice patterns. Learn stuff. Connect with other people. Find things you enjoy doing and do them. Those are just a few, but Tai Chi does support those.

Final analysis

Especially if you enjoy doing Tai Chi and your doctor says its safe, then go for it. There appears to be a potential benefit and no significant downside. That's a win by my math.

Paralympic Games

The 2020 Paralympic Games will take place in Tokyo between August 24th and September 5. You can learn more about the games from the main site here. You can also learn more about the US team of 200+ athletes here.

Check out their stories. Try to catch some of the games on TV or online. These are athletes who are competing with disabilities and showing what can be possible. Perhaps there's a sport you would like to become more involved in. These athletes may show you a way.

Check out the athletes' stories and follow your favorites on social media. What an you learn from them that you can apply to your own life?

And maybe there's not a life-changing takeaway other than, "That was awesome!" And you know what?

That's okay, too.

Hack of the Week

You don't need specialized grippers for jars and containers. Simple rubber band can make handling things with weak hands much simpler. They're cheap and come in a variety of sizes. Here's a listing on Amazon.*

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-08-02

Ep 137 - Get the Arm Back with Vagus Nerve Stimulation




A lot of the attention in stroke research is paid to the acute phase. How can we treat a stroke in the ER? What can we do so it doesn't get worse? How can we prevent strokes from happening? What can we do in inpatient rehab to help folks get better?

Those are all important things,  and the stunning innovations happening around us are amazing, newsworthy, and truly impacting people's lives in a meaningful way.

But there's not as much attention given to chronic stroke. Sure, there's some. There are people working really hard to help stroke survivors recover even years after stroke. But not as much makes it into the news.

That's one reason I was interested in Dr. Jesse Dawson's work at the University of Glasgow. The recently published a study in the Lancet about using Vagus Nerve Stimulation to drive recovery in patients years after stroke. And their procedure looks promising.

Bio

Dr. Jesse Dawson headshot. He directly faces the camera against a white background

Dr. Jesse Dawson is a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital. His research portfolio includes prevention and rehabilitation clinical trials in stroke survivors. His main interest is in improving the long-term outcome after stroke. Dr. Dawson holds a BHF/Stroke Association programme grant, HTA NIHR funding and NIH funding and runs a large outcomes adjudication system for multi-national stroke trials. He is the NHS Research Scotland lead for stroke research and sits on the editorial board of Stroke.

Dr. Dawson is currently researching the role of xanthine oxidase inhibition as a novel preventative treatment after stroke. This is the focus of a UK wide clinical trial, funded by a programme grant from the BHF/Stroke Association.

He is also studying novel treatments for upper limb weakness after stroke, including vagus nerve stimulation and robotic therapy. These studies included a large NIHR funded study, funding from Chest Heart Stroke Scotland and a collaboration with industry. 

Dr. Dawson is the Medical Outcomes Manager for the endpoint committee of the large NIH funded CLEAR III trial, the NIH funded MISTIE III study, the European Union FP-7 funded EuroHYP study and the international SITSOPEN collaboration. This involves review of all trial endpoints and co-ordination of the endpoint adjudication process for these large phase III studies.

He supervises several PhD and MD students, including students with competitive government and charitable funded fellowships. He co-directs a large MSc programme in Clinical Pharmacology and is Director of the Vertical Theme for Clinical Pharmacology and Therapeutics for the MBChB programme. He is a regular MRCP PACES examiner and external higher degree examiner for several UK univeristies.

The Research

This is a fascinating study because even though they are stimulating the Vagus nerve, they are not actually treating it. Instead they are using it as a messenger to the brain to say, "Wake up! It's time to learn something." Essentially, it's trying to get the brains attention so traditional Occupational and Physical Therapy can work. And it seems to be working. It will be interesting to see if in future studies they can get similar results with Speech Therapy.

The other important take away here is that this work with chronic stroke survivors -- folks who had strokes years ago -- even in the control group. Granted the experimental group that got the Vagus Nerve Stimulation got better results.

The point is, though, that intense physical and occupational therapy gets results even years after as stroke, demonstrating once again that the 6 or 12 month caps on recovery are complete and utter nonsense.

Hack of the Week

Pick a small thing to focus on. Perhaps it’s a small task. Or part of a small task. Or maybe it's a new goal you haven't done before but it seems within reach. Do that. Focus on that. Achieve that. The look for more small challenges. Lots of wins on small challenges adds up to big success in the long run.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Understanding Post Stroke Depression


 

Surviving a stroke is not the end of a medical issue. It's the start of a new journey, with new challenges. Major depression is often one of those challenges. It interferes with recovery, rehab, adjusting to a new life, and maintaining relationships.

In short, it's big problem. And it's pretty common.

According to new research by Dr. Laura Stein from the Icahn School of medicine, depression after stroke is twice as likely to occur as depression after heart attack. There's something unique about stroke that leads to depression.

On top of that, if a person lived with Generalized Anxiety Disorder before stroke, they are 1.7 x as likely to experience Major Depression after stroke.

In this conversation, Dr. Laura Stein talk about her research and what survivors, caregivers, and medical practitioners need to know.

Bio

Dr. Laura Stein smiles at the camera while wearing a white doctor's coat against a gray back drop

Laura K. Stein, MD, MPH is an Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers. She is board certified in Neurology and Vascular Neurology by the American Board of Psychiatry and Neurology. Dr. Stein received a BA from Amherst College and her MD and MPH from the Icahn School of Medicine at Mount Sinai. She completed her internship, neurology residency, and vascular neurology fellowship at Mount Sinai. 

Dr. Stein's interests are in stroke clinical care, stroke outcomes research, and medical education. She is the Neurology Residency Associate Program Director and precepts first year medical students in the Art and Science of Medicine preclinical skills course. Dr. Stein received the Department of Neurology Resident Class of 2020 Award of Appreciation for Dedication & Commitment Towards Excellence in Mentorship and 2020 Institute for Medical Education Excellence in Teaching Award. 

The Research

Dr. Stein's research was part of the American Stroke Association’s virtual International Stroke Conference. You can read the paper here.

You can read the article where I first encountered her work here.

The approach of looking at depression after heart attack vs looking at depression after stroke is an interesting one. It's a nice way of controlling for other potential causes.

The research looked at Medicare recipients, Medicare is a US government health insurance program, generally for folks 65 and older. It lets researchers draw from a rich collection of data. There are two significant tradeoffs, of course.

First, it's restricted to the US so there's no international representation in the study. Obviously, depending on the research question in particular, that may or may not be an issue.

Second, it's restricted to folks 65 and older. Can we say that the results of this study apply to younger stroke survivors?

Maybe?

Probably?

We don't know. And this study was not designed to answer that question. I'd say it does get us closer, though, and it opens up an opportunity to do further research that asks different but related questions.

That's what good studies do. The answer specific question with solid evidence and clear analysis. And the result can introduce new questions for researchers to explore in different studies.

In the meantime, it's likely safe to say, that regardless of age, stroke survivors are probably more likely to experience depression, and the community needs to be vigilant for the signs of depression and seek treatment accordingly.

Symptoms of Major Depression

Diagnosing depression involves identifying symptoms from a couple lists. To "earn" a depression diagnosis, a patient needs 5 symptoms from list 1 and all 4 from list 2. They are:

List 1 (Pick 5 or more)

  • Depressed Mood (most days)
  • Loss of Interest or pleasure
  • Weight loss or gain
  • Insomnia or hypersomnia (nearly every day)
  • Psychomotor agitation or limitation
  • Fatigue (nearly every day)
  • Feelings worthless or experiencing inappropriate guilt
  • Decreased concentration (nearly everyday)
  • Thoughts of death or suicide

List 2 (All 4)

  • Symptoms cause significant distress or social/professional impairment
  • Symptoms not attributable to a substance or medical condition
  • Symptoms not explained by another disorder
  • No history of manic episodes

You can read more details about the symptoms here.

You can probably see one of the issues. Many of those symptoms may be directly attributed to the disabilities and brain damage of the stroke without it being Major Depression. That's why it's important to work with a medical professional to tease them apart.

Symptoms of Generalized Anxiety Disorder

Generalized Anxiety Disorder is about more than feeling nervous. It's more complicated and severe.

The National Institute of Mental Health describes it this way:

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

You can read more about the condition here.

Neuropsychology

While most psychologists and psychiatrists can help stroke survivors and others with depression and other conditions, there is a specialty that may be even more helpful -- neuropsychology.

A while back, I talked with Dr. Karen Sullivan from I Care For Your Brain. She wrote the "Interactive Stroke Recovery Guide."*  You can listen to that conversation or learn more at http://Strokecast.com/Karen

A neuropsychologist has additional, specialized training to work specifically with folks who have brain injuries. They dive deep into the details of the injury to provide the best customized treatment plan, leveraging expertise that generalists don't have.

They work with folks with a wide array of functionality and challenges.

FLAME vs FOCUS

As long as we are talking about depression, we should also talk about antidepressants a little -- specifically SSRIs and how the relate to stroke.

In 2011, the FLAME study was published in the Lancet. In short, it demonstrated that stroke survivors who took Prozac (Fluoxetine) experienced stronger motor recovery. Many hospitals saw those results and began putting more stroke survivors on Prozac because, well, why not? If the patient tolerates it well, and it can help folks work better, it's probably a good idea. And if it reduces or prevent post stroke depression (or other depression) that's a solid win.

I talked with Dr. Nirav Shah about this back in November of 2018. You can listen to that episode here.

That's how I started on an SSRI in my stay. They originally tried Prozac with me, but I had a not great reaction to it. It apparently gave me an anxiety attack. So we quickly stopped that (thank you, Xanax, I think). We talked about it some more and tried again with a different SSRI -- Lexapro (Escitalopram) because I had tolerated it well during a tough time some years earlier.

Cheap, no negative side effects, and potentially helpful is win.

A month after my interview with Nirav, and a year and a half after my stroke, the FOCUS study came out, attempting to duplicate the results of the FLAME study on a bigger scale.

It failed.

The scientific consensus now is that SSRIs do not help with motor recovery. They do still help with depression.

The hospital no longer recommends SSRIs as part of the motor recovery protocol.

So what does that mean for folks like me?

I asked my doctor last year if that meant I should stop taking them. We talked about it and she explained I could certainly stop if I wanted to.

"But, dude -- it's 2020."

And she had a valid point.

(Okay, maybe I paraphrased that)

And that's why Escitalopram still has a place in my pill organizer.

As always, everyone's stroke and circumstances will vary, so talk to your doctor before making any changes to your medication.

Hack of the Week

Get a dog.

A dog can be helpful after stroke, whether it's a service dog or simply a companion animal.

When you have a dog, you have a responsibility to take care of it. You have to feed it, walk it, groom it, and give it cuddles.

Sometimes that may be reason enough to get out of bed and get moving for the day.

Links

Where do we go from here?

  • If you think there's a chance you might be experiencing depression, talk to your medical team
  • Share this episode with someone you know with the link http://Strokecast.com/depression
  • Subscribe to the free, monthly Strokecast email newsletter at http://Strokecast.com/news
  • Don't get best…get better.


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