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