2022-05-09

To Read, Write, and Speak Again


Sophie Salveson survived a stroke at 19. It's not the way any freshman wants to end their first year of college. She was a writer, actor, and singer. The stroke stole her right side limbs, her speech, and her access to language.

Sophia Salveson looks at the camera in an ethereal headshot.

Over the past 10 years she fought back through PT, OT, speech therapy. She learned to stand, walk and speak again. And she continues to make progress.

In the previous episode (http://strokecast.com/ExpandedPractice) I spoke with Marabeth Quinn, Sophie's Mom, and Danielle Stoller, one of Sophie's Physical Therapists. This week, we hear from Sophie and Marabeth and learn more about Sophie's journey.

If you don't see the audio player below, visit http://Strokecast.com/Sophie.

 

Song

Many people with aphasia find it easier to sing than to speak. Early treatment sometimes involves getting folks to sing their name or sing a greeting. Or even sing a song deeply embedded in their memory, like Happy Birthday.

It has to do with the way music and song live in different part of the brain.

Aphasia isn't the only place music as an impact. In episode 106, I spoke with Brian Harris of Medrhythms about his work using music to bypass limitations of the motor cortex and help people significantly improve their gait.

This is an amazing video of Sophie from 2020. You can hear her sing, "A Change in Me" from Beauty and the Beast.

Now, I really want to hear Sophie's Eponine.

Maggie and Michael

Sophie isn't the only stroke survivor with a passion for theater.

I talked with Maggie in episode 38. Since then she has acted in a theater company fill with folks with disabilities. She continues to make progress on her documentary, The Great Now What. Here's the trailer:

Michael Schutt was on the show in episode 124 talking about creating his solo show to share his stroke story. COVID lock downs meant planned performances didn't happen. He pivoted it into a radio play available on line. You can listen at http://ALessonInSwimming.com.

Sophie's Book Recommendations

The first book Sophie really read for pleasure after her stroke was "Shatter Me," by Tahereh Mafi.* It came with a powerful endorsement -- her sister's. And connecting about the book with her sister was a powerful incentive to read it, no matter what it took.

Sophie's current favorites include "Good Girl's Guide to Murder," by Holly Jackson and "Elsewhere," by Gabrielle Zevin. * Pick up a copy or find them at your library and tell Sophie what you like about her favorites.

Hack of the Week

Keep trying. Speaking with aphasia is tough, but the only way out is through the key is to keep trying and to keep working on it.

I've found it best top to try doing a thing with my affected hand three times before switching to my unaffected side. By trying three times, I'm reminding my brain that my left hand is still there and has a job to do. By stopping after three failed attempts, I stave off frustration and can try again another day.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2022-04-27

Communicate without Words


"Communication is the process by which shared meaning is created." 

CO 101

That's the first lesson we learned in Communications class back in college.

Communication isn't spoken words or written words of photos or symbols or sounds or touches. Or even scents or tastes.  Those are all just vehicles for communication. They are the trucks intended to carry the freight of meaning from one person to another.

After stroke, some of those trucks are no longer available. Aphasia and dysarthria may interfere with speech. Hemiparesis may interfere with writing or gestures. Sensory overload and attention challenges may interfere with listening.

And yet communication continues. Because the other lesson we learned in the class CO101 is, "You can't not communicate."

Combine those principles with the idea that your actions always speak louder than your words, and we have deeper understanding of how important it is for clinicians to think deliberately about the things they say and do when working with clients.

Marabeth Quin and Physical Therapist Danielle Stoller joined me in this episode to share their stories and how they came to develop Expanded Practice -- a training program for clinicians that helps them tune their communication strategies to build better relationships with their patients.

Note: This isn’t the first time I talked about communication in an academic context. This was also something I talked about with Drs. Sara Parsloe and Patricia Geist-Martin in episode 111 at http://Strokecast.com/process.

If you don't see the audio player below, visit the original post at http://Strokecast.com/ExpandedPractice.

 

Who are Danielle and Marabeth?

Danielle Stoller is a neuro physical therapist who helps stroke and brain injury survivors improve their lives through a holistic rehab approach.  Marabeth Quin uses the experiences and insights she has gained from her daughter’s stroke recovery to improve therapist’s understanding of the mental and emotional aspects at play in the recovery process.  Together they co-founded Expanded Practice.

The top half reads Expanded Practice. The bottom half includes headshots of Danielle Stoller and Marabeth Quin

Expanded Practice

Expanded Practice is the training organization that Danielle and Marabeth started  once they saw the need to help therapists connect more effectively with their patients.

Their goal in part is to go beyond the technical details of the tasks that go into a session and to help therapists think more about the client experience -- to connect to the clients as individuals with specific therapeutic, emotional, and psychological needs. That's not about providing counseling per se; it's about understanding the patient and building a trusting relationship with them to promote a more effective session.

In some ways it parallels the work I've done as a corporate training help folks learn how to sell technology products. It's not about the high-tech features of the product. It never is. It's about what those features and those products will do for the customer. Effective salespeople ask themselves, "How will this product or service make THIS customer's life better? How will this benefit them?"

To answer that, they have to talk to their customers and ask questions. They put the focus on the customers' lives.

That focus on the client is something Danielle and Marabeth teach to. As we talked about in the episode,  they teach therapists about the environment they create. If the therapist appears rushed or tense, that will affect the client's perception of what is happening. That increase in tension makes a session less effective.

Here's how Marabeth and Danielle describe the program:

Expanded Practice teaches physical, occupational, and speech therapists to start utilizing the power of positive mindsets and expectations in the recovery process so they can connect with their patients on a more significant level and help them reach greater recovery potentials.  Expanded Practice is passionate about improving the rehab experience for patients and therapists so both thrive and achieve the highest possible outcome.

Stroke Awareness Month

May is Stroke awareness month in the US.

What does that mean for you? Well, whatever you want it to.

It's a month when many survivors will share their stories or post on social media about how to recognize a stroke or just have personal conversations with others they are close to.

Some may choose more subtle signs, like adding a stroke awareness frame to a Facebook avatar or wearing a red ribbon.

Some may give a talk at school, church, or work to help raise awareness.

And many folks will choose to treat it like any other month.

What matters most is to treat it in the way that best supports your needs, goals, and recovery.

And if you want to do something, but you're not sure what, you can always tell folks about your favorite stroke related podcast :).

Or find a new stroke podcast to listen to at http://Strokecast.com/strokerelatedpodcasts.

Hacks of the week

Two guests again means 2 hacks.

Marabeth makes a point of reminding us to keep going. The thing about recovery -- whatever part you're in -- is that it can be easy to stop and give up. It seems so enticing to do that somedays. It really does.

But then you stop getting better. And you may get worse. Even when it's hard, you have to keep going. That's the only way to get to the better days that are coming.

Danielle suggested looking at trees. Even better is getting outside into nature -- even if it's just a short time. There's research demonstrating this helps with recovery.

Getting out and being near the grass and trees and plants helps. And it can be one of the cheapest things you can do to help your recovery.

Links

(If you don't see a table of links, visit http://Strokecast.com/ExpandedPractice)

Where do we go from here?


Here is the latest episode of The Strokecast

2022-04-11

When the Pros Deny a Stroke


Olga and her husband were having the vacation of a lifetime. They hooked up a teardrop trailer to their Subaru in NJ and headed out west. The planned to explore the gorgeous landscapes of the Washington State parks before jumping on ferry to Alaska.

On July 19, 2021, at a campground in Deception Pass State Park on the Washington State Peninsula, things started to unravel.

Olga had a brain stem stroke. She felt tingling up and down one side of her body and could not stop vomiting. She felt it was a stroke. Her husband called 911 and they made it out of the woods to a fire house.

The EMT said she wasn't having a stroke.

The ambulance that arrived said she wasn't having a stroke.

The ER staff said she wasn't having a stroke.

The neurologist said she probable wasn't having a stroke and specifically discouraged the tPA that could have solved the problem

And no one sent her to the more advanced hospitals in Seattle for stroke treatment.

The window for tPA came and went.

This whole time, Olga was having a stroke.

Olga shares her story in this conversation.

If you don't see the audio player below, visit http://Strokecast.com/Olga

 

Who is Olga Wright?

Olga stands in the woods looking at the camera. Shea wears a brown puffy jacket.

Olga is a married mother, grandmother, and recently retired educator. She lives in central New Jersey, where she practices extreme gardening.

She and her husband recently returned from a six-month, 24,000-mile road trip to Alaska and back, with their ultra-light, solar-powered camper.

Her goal is to educate the public and medical professionals at all levels to recognize nausea, vomiting, and tingling as stroke symptoms so that no one else is misdiagnosed as she was.

Olga can be reached at olgawrightstrokestory@gmail.com

Deception Pass

Deception Pass State Park is a gorgeous corner of the state. It's filled with hiking trails (including accessible trails), lakes, salt water shoreline, and campgrounds.

It's also just an amazingly beautiful part of the state. It seems remote but it's also within just a couple hours of Seattle to the Southeast and 90 minutes from Canada to the north.

It's easy to see why Olga and her husband chose to camp there.

Zofran and the Brain

Zofran is a medication I was not familiar with, and it's what finally got Olga's vomiting under control.

It's typically used to help treat nausea associated with chemotherapy. In Olga's case, it was used to treat a malfunctioning brain that was sending the signal of, "OKAY! Everyone out the way you came in!" even though there was nothing left.

The brain tries to protect us in lots of ways. Sometimes those threats are real and sometimes they are not. In Olga's case, her dying brain stem knew something was wrong but didn't know what. It went to an early reflex for poison and just kept trying the expulsion solution because it didn't know what else to do. Meanwhile, Olga's higher level brain functions were still working and trying to seek medical treatment for the stroke.

And this conflict is an illustration that the brain is not one, cohesive unit. It's different parts grabbing different pieces of data and attempting to execute a solution based on the tools at its disposal. The brain does not always work as a single unit.

But back to Zofran. One of the interesting things I learned while reading about it is that Serotonin, one of the brain's "happy" chemicals is also responsible for the vomiting function/command. Zofran works by suppressing Serotonin.

And that makes me wonder how its use as an antiemetic impacts things like depression. I suppose that will be a future research project.

Swedish ARU

The reason Olga and I connected is that she spent her inpatient rehab time at Swedish Medical Center. It's the same place I lived for the month following my stroke. You can learn more about the Acute Rehab Unit here.

Olga was lucky enough to work with OT Emilee who told her about the Strokecast. Emilee was also one of my OTs 4 years before Olga made it there. I interviewed Emilee in episode 20. You can hear that conversation here: http://Strokecast.com/Emilee

I've stayed engaged with members of my rehab team over the years. I've also met other folks on the stroke team at Swedish. Here are some other interviews I've done with the team at Swedish: http://strokecast.com/Swedish

Licensing for PT and OT

The pandemic has brought a dramatic increase in the availability of telemedicine. This is great because a lot of follow up appointments really don't need to be in person. I'd much rather do a 15 minute video appointment versus a 15 minute in person appointment I have to travel to and back from.

In Olga's case, it almost worked out for Outpatient PT. She would be able to continue her travels after leaving the hospital and get therapy on the road via the internet!

It’s a great idea, but it didn't work. Not because of technology or willingness, but because of state level bureaucracy. A Washington licensed physical therapist cannot legally treat a patient who happens to be in Alaska or whatever other state Olga happened to be travelling through.

Hack of the week

Walking is one of the best ways to drive recovery. At certain points, walking 100 feet may be the most you can do. At other points, a mile or two may be achievable. Regardless of the distance, walking as much as you can helps to drive recovery.

The most important thing, though, is to do it safely. Olga uses traction cleats for all her hiking activities. Traction cleats are basically snow chains for your feet. Even if there's no snow, they help traverse the wilds with less slipping and falling. You can find an assortment on Amazon here: https://strokecast.com/Hack/TractionCleats *.

A walker or cane can be great in a city environment, but they are less usable on the trail. What is usable whether hiking in Alaska or going down to the corner bodega is a pair of trekking poles. These are much taller than a cane. As you use them they give many folks plenty of stability and an upper body work out. You can find them on Amazon at http://strokecast./com/Hack/TrekkingPoles *.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2022-03-28

Researching Brain Blood Clots


More than 80% of strokes are caused by blood clots. These strokes are called "ischemic" because the clot block the flow of blood through a blood vessel, starving brain cells of oxygen and nutrients. My own stroke was ischemic.

There are new treatments to clear the clot and restore blood flow and we talk about them a lot on this show. What we don't usually discuss is the nature of clots themselves and how that impacts patient recovery.

So this episode is a little different. We go deep into understanding the biologfy of blood clots with Michael Gilvarry and Dr. Patrick Brouwer from Cerenovus, a Johnson & Johnson company.

Cerenovus commits a lot of research and resources to understanding clots because they make equipment used in Mechanical Thrombectomy and reduce the impact of stroke on thousands of patients a year.

You can listen to the conversation here or in your favorite podcast app. If you don't see the audio player below, visit http://Strokecast.com/Clots

 

Meet Dr. Patrick Brouwer and Michael Gilvarry

Dr. Patrick Brouwer, Head, Worldwide Medical Affairs - CERENOVUS

Dr. Patrick Brouwer looks directly at the camera in this professional headshot

Dr. Patrick Brouwer is a clinician and scientist who has made significant contributions in the field of interventional neuroradiology and endovascular surgery.

Before joining CERENOVUS as Head of Worldwide Medical Affairs, he served in senior staff positions for over 20 years as a neurointerventionalist at various university hospitals in Europe. As a key opinion leader in his field, Patrick has published close to 100 scientific papers and book chapters and lectured, including for invited professorships, on more than 400 occasions around the world on a variety of topics related to neurointervention.

Patrick has additionally contributed by serving in various board positions across key societies, such as the European Society of Minimally Invasive Neurological Therapy (ESMINT) and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN).

He received his medical degree, with honors, from the Free University in the Netherlands.

Connect with Dr. Brouwer on LinkedIn.

Michael Gilvarry, General Manager, CERENOVUS Galway

Michael Gilvarry looks directly at the camera in this professional headshot

Michael Gilvarry is the General Manager of CERENOVUS in Galway. With a distinguished career in research and development (R&D) spanning over 20 years, Michael leads the CERENOVUS campus in Galway which is a key hub for producing world-class leading research on stroke and clot science, as well as R&D for the business’ product pipeline.

He leads a distinguished team who informs new innovations and the development of medical devices to address real-world challenges faced by neurovascular physicians in the treatment of stroke. This work has led to many international research projects in collaboration with universities and hospitals in the field of acute ischemic stroke.

He is the recipient of a Johnson Medal, the most prestigious award for R&D excellence within Johnson & Johnson, and is a named inventor on over 60 U.S. patents.

Connect with Michael on LinkedIn.

Cerenovus

CERENOVUS, part of Johnson & Johnson Medical Devices Companies, is an emerging leader in neurovascular care. Our commitment to changing the trajectory of stroke is inspired by our long heritage and dedication to helping physicians protect people from a lifetime of hardship. CERENOVUS offers a broad portfolio of devices used in the endovascular treatment of hemorrhagic and ischemic stroke. For more information, visit www.cerenovus.com and connect on LinkedIn and Twitter.

Cerenovus corporate logo

Nature of clots

Most folks who encounter clots only experience them on the surface of the body or when they come out of the body, but we don't think too much about their nature, especially wqhen they stay inside the body.

At the most basic levels, the structure of a clot is determined by the ratio of fibrin to red blood cells. Clots that are high in fibrin tend to be "tougher" and more compact, thanks to the way platelets help tighten them up. That also makes them easier to remove with Mechanical Thrombectomy.
 Clots that are higher in red blood cells may be softer and less dense, but they are also more fragile. Pulling one out of a blood vessel in one piece is a lot harder.

An environment with higher sheer forces is more likely to generate a high-fibrin clot. What is a high sheer environment? Think about a river with a strong, fast flowing current. One way to get a high sheer environment is with high blood pressure. With high blood pressure, blood is coursing through less flexible vessels with greater speed and strength.

A high red blood cell clot is more likely to be formed in a turbulent environment. AFIB, or atrial fibrillation is one such environment. A space where blood flows unevenly or pools can lead to a clot like this which can then travel to the brain.

Clots can also be different shapes. It's not like they are just a disk that closes off a blood vessel. They could be in the shape of a cylinder blocking a blood vessel. The can easily be longer than 8 mm.

Cerenovus recently presented a paper at the American Heart Association's International Stroke conference looking at the impact of clot composition on patient outcomes in mechanical thrombectomy. They showed that thrombectomy had better patient outcomes with high-fibrin clots.

Of course, today there really isn't a way from a neuro-interventionist to know the type of clot before they go in to get it. In the future such information may help inform treatment protocols or refine the type of equipment used in the clot removal process.

You can read more about the research paper here.

What is AFIB?

More than 12 million people in the US live with Atrial Fibrillation. It's a condition that can easily lead to stroke.

Afib happens when the heart gets out of sync with itself. The upper chambers don't beat in the same rhythm as the lower chambers. That results in inefficient blood flow through the heart. Not all the blood that should leave on a beat actually leave.

Bill pulls down the neck of his t-shir to reveal a Zio Patch heart monitor taped to his chestBill's Zio Patch heart monitor is looking for signs of Afib. It did not find any.

This results in blood pooling in the heart and creating a turbulent environment that is a breeding ground for blood clots. Eventually one of those clots will shoot out of the heart and lodge in the brain causing an ischemic stroke.

 When I got home from the hospital, I wore a heart monitor for two weeks that looked for signs of Afib. It did not find any.

Folks with Afib, and especially a history of Afib-related stroke may be put on a lifelong course of anticoagulant medication to prevent those clots from forming. There may be other treatments, as well.

What happened to my clot?

I had a wakeup stroke in 2017. As a result, I was outside the window for tPA and thrombectomy at the time. So what happens when the clot doesn't get removed? I just assumed it would break down over time and blood would start flowing through the dead brain tissue again.

But that's probably not what happened. Because the blood vessel where I had my stroke is so small, it's likely still in place. That clot never went away. It simply became part of the blood vessel itself and that part of the system permanently collapsed. Basically, the cave collapsed and there's no way to dig it out.

And now I'm imaging some sort of Fantastic Voyage/D&D crossover game to go explore that cave.

Meade Musings

I recently appeared on the Meade Musings Podcast sharing my story. We talk about my stroke  and the impact of Sleep Apnea on blood pressure. You can hear the episode here. If you don't see the player below, visit http://Strokecast.com/clots

JoCo Cruise

I just got back from the JoCo Cruise. It's a weeklong cruise in the Caribbean with 1800 nerds, geeks, gamers, creators, and more. We chartered the Nieuw Amsterdam cruise ship for the journey and had a blast. The crew was great and my fellow cruisers were fantastic.

Unlike a traditional cruise, the official programming is all done by the group that charters the boat, led by musicians Jonathan Coulton and Paul & Storm. They bring on a bunch of other well-known and soon to be well known musicians, writers, voice over folks, actors, and generally fun, nice, talented people.

And then the attendees ourselves put together a bunch of programming. I ran a meet up for folks with neuro conditions, a professional networking session, a podcaster meetup, and a photoshoot for the stuffed animals people travelled with.

I have lots of other thoughts and feelings about this year's cruise, but I'm having trouble articulating them in writing this time.

If you'd like to learn more or are thinking about going in 2023 (or in the future) you can visit http://JoCoCruise.com for more details

https://youtu.be/5spvXMkF20g

Hack(s) of the Week

Hack 1

Dr. Patrick Brouwer emphasized the importance of setting goals and appreciating the life around you. At first glance it seems those two things are in conflict, but in reality, they are not.

Setting goals helps you build a plan for the future with tasks you can do today that can get you there.  The steps you take today are what will shape your future. And if the steps you take can get you there, there is fulfillment to be found in taking them.

At the same time, we don't live in the future. We live in the present. It's the only reality we will ever have. We need to appreciate the world and the people around us and if we can't then we need to take steps to change that. And execute those steps while recognizing the sheer power of the here and now. Because before we know it, the here and know will simply be the past.

Survivors who've come close to not having any more future on this earth can appreciate that more than most.

Hack 2

Michael Gilvarry talked about adding additional therapy while doing other tasks. He suggested closing your eyes while you brush your teeth. It's something he found helpful while rehabbing his own knee.

I like this approach especially for folks after stroke because it forces you to work on proprioception - the sense of where your body parts are in space. This is a challenge for many survivors. It's a skill we may need to develop.

It also forces use to focus more on the balance in our core and affected leg while our unaffected hand is busy with the tooth brush.  This can be a good challenge after stroke.

That said, do it safely. Make sure you can stand with your eyes closed without falling, first. Talk to a PT or OT before trying things like this. You want to challenge your brain with these balance tasks, but any fall could undo months of progress.

So don't fall.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2022-03-07

How can you do 1,000 reps an hour?


Again and again, we learn the secret to stroke recovery is repetition. It's about doing the same movement or behavior again and again -- tens of thousands of times.

In a typical session with an OT or PT, a patient might do the same exercise 30-60 times, which is a good start. But what if a therapist could crank that up to 1,000 reps an hour, or one every four seconds? Now you've got some interesting possibilities for recovery.

Bionik, Inc makes devices and software that do just that. This week I talk with CEO Rich Russo about the InMotion Hand and InMotion Arm devices and how they work in conjunction with a therapist to help patients recover.

Listen to the conversation here or in your favorite podcast app. If you don't see the media player below, visit http://strokecast.com/Bionik

 

Who is Rich Russo?

From the Bionik website:

Rich Russo wears a dark suit, shirt and ties. He;'s outside and looking at the camera

Mr. Russo Jr. has over 15 years of finance and accounting leadership experience and is a Certified Public Accountant.

From March 2017 through November 2020, Mr. Russo was the Vice President of Finance and United States Chief Financial Officer, of IcarbonX, a privately held digital health management company specialized in artificial intelligence and health data, and a predecessor PatientsLikeMe. While there, he was responsible for, among other things, the merger of three companies, fundraising, and the ultimate dissolution of certain affiliated companies.

From 2007-2016, Mr. Russo held various key leadership roles for Nasdaq-listed companies in life sciences, pharmaceutical and medical device industries. From September 2015 to October 2016, he served as Corporate Controller for Pieris Pharmaceuticals, Inc., a clinical stage biotechnology company, and prior to that, he had roles at Juniper Pharmaceuticals, a woman’s health company focused on developing therapeutics, and Cynosure, a medical device company focused on aesthetic treatment systems. In each of these roles, Mr. Russo was responsible for all finance activities and SEC reporting, including partnering closely with management to ensure effective and efficient financial procedures throughout the organizations. Mr. Russo started his career in 2005, where he served as an auditor at Pricewaterhouse Coopers in the assurance group.

Mr. Russo is a graduate of Bridgewater State University in Bridgewater, MA, where he graduated from a dual degree program, receiving his Bachelor of Science in Accounting and his Masters in Management and Accounting.

Other Inpatient Solutions

A patient uses the InMotion Hand

The Bionik system is one for hospitals and rehab units. The rapid reps help in partnership with the rehab professional.

In that respect, it's similar to devices from Restorative Therapies. I talked with the team at Restorative Therapies in episode 92. You can find that episode here. 

The key difference is that Restorative Therapies uses Functional Electric Stimulation (or FES) to activate a patients muscles. The Bionik solutions provide physical assistance to help the patient complete motions. They are different ways to stimulate the brain, increase repetitions, and drive the neuroplasticity that is so key to recovery.

They are also both intended for use in a hospital or rehab facility with the help of a trained therapist.

The other devices I talk about often, like those from sponsor Motus Nova and previous guests with Neofect and Racoon Recovery are for at home use, as a supplement to therapy provided at a medical facility, or as an alternative when those services are not available, for whatever reason. You can learn more about those devices by clicking the links on their names above or from the link table at the bottom of this post.

The point of all these solutions is the same -- drive patient recovery through increased movement and repetitions to neureoplastically teach to brain how to access that limb once again.

Hack of the Week

Wear comfy socks.

It's such a simple thing, but the right socks can make a big difference in how you feel. The right socks can wrap your feet well and wick away perspiration. They can protect your foot from rubbing against an AFO or the heel of your shoe.

The wrong socks will keep you too hot or too cold. The wrong size will leave you with an uncomfortable wrinkle you walk on all day. If they're too slippery, you've got an additional safety hazard to contend with.

The hospital socks they gave me in the hospital were terrible. The had the no slip dots, which was great, but they kept falling down and rotating around my foot. Part if it was they were likely the cheapest that met minimum standards. The other part is that I have large feet for my height (size 12). So my partner ordered me better hospital socks from Amazon,* which helped.

For air travel after stroke, I have made a change to my wardrobe. I now wear knee-high compression socks.* They do a good job of preventing swelling in my feet and legs during long flights. And that helps to prevent DVT or deep vein thrombosis, which is where a clot forms in the legs and causes problems there, or breaks loose and lodges elsewhere in the body. That's how Ted Baxter had his stroke. I talked with Ted back in Episode 34.

Relatively speaking, good socks are still fairly cheap. Try different ones until you find the socks that are best for your feet and life style.

Good socks are worth it.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2022-02-28

A Hole in my Heart - Should I get it fixed?

If you have a hole in the middle of your heart and it's not supposed to be there, is that a problem? Should it be fixed? The answer is a resounding, "Maybe."

Dr. David Thaler and his colleagues looked at the impact of PFO closure on stroke patients and found that often, the best solution is to leave it alone. They developed a scoring system to help neurologists and cardiologist make the best decision on a patient-by-patient basis.

Dr. Thaler joins me in this conversation to talk about the research and recommendations.

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

About Dr. Thaler

Dr. David Thaler stand in a medical office wearing his white doctor coat, looking at the camera.

Dr. David Thaler, MD, PhD, FAHA, is the Neurologist in Chief at Tufts University Medical school. He is the Chairman and an active professor in the Department of Neurology.

Additionally, he continues to treat patients and is a clinician focused on stroke care. He  continues to work to advance the field with a research focus on acute management of cerebrovascular disease, secondary stroke prevention, cryptogenic stroke and patent foramen ovale (PFO).

Dr. Thaler's training involves work at:

  • Oxford University
  • John Radcliffe Hospital, UK
  • Brigham and Women's Hospital
  • St. Elizabeth's Medical Center

He is a Board Certified specialist in Neurology and Vascular Neurology.

Stroke Basics with Dr. David Thaler

Dr. Thaler works on projects ranging from advance neurological  research to the fundamentals of stroke education. This video is an excellent, short introduction to stroke  that is also sharable:

https://youtu.be/i_gtxYQlECc

One of the things that is especially interesting about this video is that in describing the symptoms of stroke the first one he mentions is tingling on one side of the body. This usually isn't mentioned as a stroke symptom by most warnings.

In episode 156, coming up in a few weeks, I talk with a survivor who had this exact symptom and was told by first responders that she definitely wasn't having a stroke and by emergency room personnel that she probably wasn't having a stroke. It turns out she was having a stroke.

BEFAST and AHORA are excellent starting points for recognizing the signs of a stroke, but they are not comprehensive. They do not cover every sign of stroke. They are just a useful short hand.

Stroke symptom graphic highlighting BE FAST (Sudden change in Balance, Eyesight, Facial symmetry, Arm control or speech/language means it is time to call and ambulance),

A graphic of the AHORA pneumonic device to help spanish speakers recognize a stroke.

What is a PFO?

A PFO is a hole in the heart. Roughly 25% of the population has one. I have one. Guests Misha Montana and Christine Lee both had PFOs that led to their strokes.

After we are born, our blood follows a path through the heart. It comes in the right side. When the heart beats, the blood on the right side heads out of the heart to the lungs. There, it drops of CO2, picks up oxygen, filters out clots, and heads to the left side of the heart. It will pour into the left side and when the heart beats, it sends that oxygen-rich blood on to the brain and other parts of the body. Then that blood drops off its oxygen, picks up CO2, and heads back to the right side of the heart to start the whole cycle over.

Before we are born, though, the process is different. While we are developing in our mothers' uteruses, we don't breath air. All the oxygen and nutrients we need to build fingers and toes and kidneys and hearts and brains comes from the umbilical cord.

Since we're not breathing air, there's no point in sending blood to the lungs. Instead, in utero it goes straight from the right side of the heart to the left side of the heart through a hole in the middle. That hole is called a Patent Foramen Ovale, or a PFO. It normally closes on its own shortly after we are born.

A quarter of the time it doesn't close after birth, and that allows unoxygenated, unfiltered blood to sneak across the heart, skip the lungs and drag a blood clot to the brain.

So, if you've had a stroke, and you have a PFO, should you have surgery to close that hole? Maybe.

Christine and Misha had their PFOs closed. I did not

Dr. Thaler's research helps doctors make the best recommendation for the patient: to close or not?

Neurology, Illustrated

When you visit the doctor's office, what do you see on the walls? Probably posters showing the warning signs of stroke or heart attack. Maybe information about COVID-19 protection and policies. Probably lots of important, useful, stressful, and boring text.

If you visit the Neurology department at Tufts Medical Center, you'll have a different experience. There you'll see art all about neurology -- from centuries old brain drawings to photos reflecting the impact of stroke on world events to modern pieces exploring the diversity of the brain and nervous system we live with today.

You can also see these images and read more about them at  Neurology, Illustrated on the Tufts website.

Here's a video of Dr. Thaler explaining the program.

https://youtu.be/hNodeeqhK8c

International Stroke Conference Panel

I will be moderating a panel for the Stroke Connection program from the American Heart Association's International Stroke Conference called "Post-Acute Rehabilitation After Stroke: Getting It Right." I'm pretty excited about it.

The Stroke Connection program is in its second year. It's goal is to connect researchers and academics with the general stroke community. The idea is that we can all benefit when scholarly scientific research is shared with the broader community.

Tickets to the webinar are available from the American Heart Association for $10 each. You can learn more, see the list of all the available webinars, and register to attend here: https://www.stroke.org/es/stroke-connection/iscstrokeconnection/stroke-connection-at-isc-registration

Hack of the Week

Slow down. Kawan Glover explained that doing tasks after stroke often means stopping and pausing for a few seconds to think about what you want to do. How can you break your task down into smaller tasks and movements.

In the pre-stroke days, we could more easily do tasks that involve all sides of our body without even thinking about it. A subtle shift of weight or minuscule flex of a finger could be all it takes to complete a particular movement.

We built this symphony of movement gradually over the years from the time we are a new born exploring our limbs to the time of our stroke.

After stroke, we may be tempted to do physical things the same way we did before, but we might not be able to yet. The symphony is broken. The automated process is broken. And the consequences could be anything from failing a task to spilling a beverage to falling and picking up another head injury.

To reduce the chances of that happening, pause. Take a breath. Break down a task into multiple little steps and figure out how to accomplish them. Then do it.

As the carpenters say, "Measure twice. Cut once,"

Links

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

Where do we go from here?


Here is the latest episode of The Strokecast

A Hole in my Heart - Should I get it fixed?


If you have a hole in the middle of your heart and it's not supposed to be there, is that a problem? Should it be fixed? The answer is a resounding, "Maybe."

Dr. David Thaler and his colleagues looked at the impact of PFO closure on stroke patients and found that often, the best solution is to leave it alone. They developed a scoring system to help neurologists and cardiologist make the best decision on a patient-by-patient basis.

Dr. Thaler joins me in this conversation to talk about the research and recommendations.

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

About Dr. Thaler

Dr. David Thaler stand in a medical office wearing his white doctor coat, looking at the camera.

Dr. David Thaler, MD, PhD, FAHA, is the Neurologist in Chief at Tufts University Medical school. He is the Chairman and an active professor in the Department of Neurology.

Additionally, he continues to treat patients and is a clinician focused on stroke care. He  continues to work to advance the field with a research focus on acute management of cerebrovascular disease, secondary stroke prevention, cryptogenic stroke and patent foramen ovale (PFO).

Dr. Thaler's training involves work at:

  • Oxford University
  • John Radcliffe Hospital, UK
  • Brigham and Women's Hospital
  • St. Elizabeth's Medical Center

He is a Board Certified specialist in Neurology and Vascular Neurology.

Stroke Basics with Dr. David Thaler

Dr. Thaler works on projects ranging from advance neurological  research to the fundamentals of stroke education. This video is an excellent, short introduction to stroke  that is also sharable:

https://youtu.be/i_gtxYQlECc

One of the things that is especially interesting about this video is that in describing the symptoms of stroke the first one he mentions is tingling on one side of the body. This usually isn't mentioned as a stroke symptom by most warnings.

In episode 156, coming up in a few weeks, I talk with a survivor who had this exact symptom and was told by first responders that she definitely wasn't having a stroke and by emergency room personnel that she probably wasn't having a stroke. It turns out she was having a stroke.

BEFAST and AHORA are excellent starting points for recognizing the signs of a stroke, but they are not comprehensive. They do not cover every sign of stroke. They are just a useful short hand.

Stroke symptom graphic highlighting BE FAST (Sudden change in Balance, Eyesight, Facial symmetry, Arm control or speech/language means it is time to call and ambulance),

A graphic of the AHORA pneumonic device to help spanish speakers recognize a stroke.

What is a PFO?

A PFO is a hole in the heart. Roughly 25% of the population has one. I have one. Guests Misha Montana and Christine Lee both had PFOs that led to their strokes.

After we are born, our blood follows a path through the heart. It comes in the right side. When the heart beats, the blood on the right side heads out of the heart to the lungs. There, it drops of CO2, picks up oxygen, filters out clots, and heads to the left side of the heart. It will pour into the left side and when the heart beats, it sends that oxygen-rich blood on to the brain and other parts of the body. Then that blood drops off its oxygen, picks up CO2, and heads back to the right side of the heart to start the whole cycle over.

Before we are born, though, the process is different. While we are developing in our mothers' uteruses, we don't breath air. All the oxygen and nutrients we need to build fingers and toes and kidneys and hearts and brains comes from the umbilical cord.

Since we're not breathing air, there's no point in sending blood to the lungs. Instead, in utero it goes straight from the right side of the heart to the left side of the heart through a hole in the middle. That hole is called a Patent Foramen Ovale, or a PFO. It normally closes on its own shortly after we are born.

A quarter of the time it doesn't close after birth, and that allows unoxygenated, unfiltered blood to sneak across the heart, skip the lungs and drag a blood clot to the brain.

So, if you've had a stroke, and you have a PFO, should you have surgery to close that hole? Maybe.

Christine and Misha had their PFOs closed. I did not

Dr. Thaler's research helps doctors make the best recommendation for the patient: to close or not?

Neurology, Illustrated

When you visit the doctor's office, what do you see on the walls? Probably posters showing the warning signs of stroke or heart attack. Maybe information about COVID-19 protection and policies. Probably lots of important, useful, stressful, and boring text.

If you visit the Neurology department at Tufts Medical Center, you'll have a different experience. There you'll see art all about neurology -- from centuries old brain drawings to photos reflecting the impact of stroke on world events to modern pieces exploring the diversity of the brain and nervous system we live with today.

You can also see these images and read more about them at  Neurology, Illustrated on the Tufts website.

Here's a video of Dr. Thaler explaining the program.

https://youtu.be/hNodeeqhK8c

International Stroke Conference Panel

I will be moderating a panel for the Stroke Connection program from the American Heart Association's International Stroke Conference called "Post-Acute Rehabilitation After Stroke: Getting It Right." I'm pretty excited about it.

The Stroke Connection program is in its second year. It's goal is to connect researchers and academics with the general stroke community. The idea is that we can all benefit when scholarly scientific research is shared with the broader community.

Tickets to the webinar are available from the American Heart Association for $10 each. You can learn more, see the list of all the available webinars, and register to attend here: https://www.stroke.org/es/stroke-connection/iscstrokeconnection/stroke-connection-at-isc-registration

Hack of the Week

Slow down. Kawan Glover explained that doing tasks after stroke often means stopping and pausing for a few seconds to think about what you want to do. How can you break your task down into smaller tasks and movements.

In the pre-stroke days, we could more easily do tasks that involve all sides of our body without even thinking about it. A subtle shift of weight or minuscule flex of a finger could be all it takes to complete a particular movement.

We built this symphony of movement gradually over the years from the time we are a new born exploring our limbs to the time of our stroke.

After stroke, we may be tempted to do physical things the same way we did before, but we might not be able to yet. The symphony is broken. The automated process is broken. And the consequences could be anything from failing a task to spilling a beverage to falling and picking up another head injury.

To reduce the chances of that happening, pause. Take a breath. Break down a task into multiple little steps and figure out how to accomplish them. Then do it.

As the carpenters say, "Measure twice. Cut once,"

Links

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

[wptb id=2697]

Where do we go from here?


Here is the latest episode of The Strokecast

2022-02-11

Stroke in your 20s Will Change Your Path


A stroke is, of course, a traumatic event. It kicks off a deep dive into the medical system of whatever country you're in.

For some, the first stroke is just a preview. Or even an intermission in other ongoing medical issues. That was the experience of Kawan Glover.

He's come back from multiple strokes and brain surgeries to be an author, coach, and speaker. And he did all that before he was 25. Today, I talk with Kawan about his journey.

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

 

About Kawan

From KawanGlover.Com

Kawan Glover stands outside in front of a brick building with his hand on his chin looking at the camera.

In the summer of 2014, Kawan noticed a lack of coordination and muscle control, specifically on his right side. One morning, while working at his internship, it became clear he had difficulty speaking and writing. He was instructed to go to the Doctor's off where they ran neurological tests. After seeing the results, the Doctor strongly advised Kawan to go to the Hospital. Kawan was not alarmed and felt the issue was being overblown.

Despite what he felt, Kawan heeded the Doctor's instructions and went to the Hospital of Southern Maryland. There he waited six hours to get a CT scan. After some time, the Doctor came out to shed light on what, if anything, was wrong. The Doctor told him he had a lesion (area of tissue that has been damaged through injury or disease) on his brain, but he would need an MRI to get more in-depth details. To get the MRI done, Kawan went to George Washington Hospital. The imaging came back and the doctors told Kawan he had a Cavernous Malformation. Kawan didn't know what that meant, so he thought nothing of it when he was told to go home and monitor.

Within a few days, Kawan was back in the Hospital when his coordination worsened, and his vision became blurry. He returned to GW Hospital and had his first brain surgery on August 15th, 2014. That may have been a moment of pause and reflection for most, but at 20 years old, there was no stopping Kawan. Only a week later, he returned to school and everything that came with it. Drinking, partying, and staying up late. As a result, he had a stroke a month later, on September 18th, 2014. After spending a month in rehab, he returned to school with a new mindset, but yet again, life had other plans.

The benign brain tumor would grow back twice, resulting in two more brain surgeries on October 1st, 2015, and October 12th, 2017. In between those surgeries, Kawan struggled with suicidal ideations, depression, and opioid addiction. After everything was over, Kawan had a whopping medical bill of $1.2 million. Despite all his hardships, Kawan still graduated and started a coaching business called Overcome Adversity LLC. He is also a Podcaster with a podcast called Favor: The Podcast. All fitting for someone with his background.

Kawan wrote a book called "Favor: How Stroke Struggle and Surgery Helped Me Find My Life's Purpose"* He is an author, a coach, but most notably a survivor. He now uses his story to inspires others, and transform them from a victim to a Victor!

Favor ain't fair. It's Just Favor.

Kawan quoted his grandmother as saying, "Favor ain't fair. It's Just Favor." Good things and bad things will happen to good people and bad people.

We can complain all we want that it isn't fair. It isn't just. And maybe it's not. Maybe we lived a good life. We were nice to everyone. We took care of the less fortunate. We respected our partners, friends, and family when appropriate. And stroke still happened.

Maybe we did all the health stuff right:

  • No smoking
  • No illicit drugs
  • No excessive alcohol consumption
  • Healthy diet and exercise
  • Appropriate blood pressure and blood sugar
  • Etc.

And we still had a stroke. Maybe no one even knows why.

It's not fair.

Now that we know that, what are we going to do about it?

We can mourn the loss of our previous life -- the hopes and dreams we don't think we can entertain anymore. Grief and mourning are fine. Healthy even.

But then what?

Favor ain't fair.

We've still got to live our lives. Just because it's not fair is no reason to stop and give up. There's so much more for us to do.

The Power of the V

Kawan talked about the  nature of the V. I like the representation of the shape.

The idea is that at our lowest point in life, we've fallen down into a valley. We may be hurt or injured from that fall. But that's only half the letter V. To make it to victory, we have to climb back up the other side of that V to get out of that valley of pain and loss and figure out the next step for ourselves. Climbing that V -- getting out of the bottom of that trough is hart work.

That's where it's important to leverage the community around us. The other survivors still climbing out of their own Vs and those who've made it can help. The family and friends around us who want us to succeed can help. We can help ourselves through our own efforts.

And as we start to climb the V, a look over our shoulders will show us other people just trying to start their own climb or thinking about starting their own climb. We can help our own efforts, too, by helping them, and sharing our own tips of the best routes, paths, and climbing gear.

Hack of the Week

Kawan mentioned floss picks.* This is a great tool for flossing one handed. They're basically disposable picks with an inch or so of dental tightly strung between 2 ends. It makes it easy to hold with one hand and slip (or force) the floss between your teeth.

This is especially important if you have face weakness. After a stroke, it's easy to fall into the habit of having food bits accumulate on the affected side of our mouth as we eat. We don't feel them as much and the assorted muscles in our mouth are not as effective at getting rid of everything.

Plus, after stroke, I picked up some tendencies of a toddler. Everything ended up in my mouth -- key fobs, credit cards, tough-to-open bags, and more. My mouth became an emergency hand. That probably wasn't a good idea, but for many of us, it is reality.

The point is that dental hygiene -- brushing AND flossing -- is even more important after a stroke. Take care of your teeth. You don't want to add more dental issues on top of the other issues you're dealing with.

Floss picks like these can help. *

Links

(If you don't see the table of links below, visit http://Strokecast.com/KawanGlover)

Where to we go from here?


Here is the latest episode of The Strokecast