Stress, Stroke, and Hormones

What is stress and how does it impact stroke recovery? In this episode, I talk with Speech Language Pathologist, Wellness coach, and endocrinology expert Michelle rusk about the nature of stress and the role of Cortisol in our bodies.

Modern life is stressful enough without contending with stroke and recovery. Add more mundane and major sources of stress to our lives on a daily basis drives out bodies to a continuous state of Fight, Flight, or Freeze. Overtime, that causes more health problems, which introduces more stress to the system

Breaking the cycle of stress requires that we understand more about it and  just how it impacts our bodies.

If you don't see the audio player below, visit http://Strokecast.com/Stress to listen to the conversation


Who is Michelle Rusk?

Michelle Rusk smiles at the camera in this selfie taken in a kitchen.

Michelle Rusk is a North Carolina based Speech Language Pathologist, licensed to treat patients in North Carolina and Virginia. She is also a Wellness Coach and Dutch Test practitioner working with clients from all over.

She owns and operates Coastal Speech Therapy and Wellness. Coastal Speech Therapy & Wellness is a private practice offering virtual therapy throughout Virginia and North Carolina for those with brain injury. She serves patients as a therapist, certified brain and hormone health coach, and DUTCH test practitioner.

What is Cortisol?

Cortisol is one of the body's stress hormones. When an emergency arises, the body dumps cortisol into the system to increase blood pressure, blood sugar, and other mechanisms that give us extra resources to run away or fight a threat.

Humans have been around for about 100,000 years. Up until the last hundred years or so, that system worked fine. Modern life though, for all the wonderful and amazing things it offers, introduces a lot of low level stress that builds and builds.

In response, our bodies push more cortisol into the system. We end up living with a higher level of cortisol than we were ever meant to. That contributes to a whole array of health issues.

As Michelle explains, the way to address that is with lifestyle changes,

What is the Dutch test?

Michelle uses the Dutch test with her wellness patients. It's a urine test that assesses the levels of hormones in a person's system, with cortisol being the big one.

The company actually offers a variety of tests that work in different ways to assess hormone levels. You collect the samples at home, send them off to the lab, and then get the detailed results.

You can learn a lot more about the tests and see sample reports at http://DutchTest.com.

Once you get results, you should discuss them with your doctor or medical team. Actually, it's probably a good idea to talk with your medical team first because these tests can cost several hundred dollars and generally won't be covered by health insurance.

Social Wellness Groups

Michelle's comments on social wellness groups are also interesting.

An online or in person stroke support group is a powerful thing. There's a lot of value in connecting with other survivors. It's not just about getting tips for living with stroke or learning about local resources, though.

It's about the community.

Often we can go through our days isolated. Most of the people we talk to have not experienced a stroke. They can't understand our experience.

In a support group, though, we're around people who do "get it." And that's a big deal.

A social wellness group takes that to another level. There are the benefits of the community, sure, but there's the added benefit of the instructor led skill development. Michelle is able to coach conversational norms, among other things, to help reduce the sense of isolation out in the real world.

Michelle on Discharge Day

Michelle mentioned how amazing discharge day is, even if it is tinged with sadness as the relationship changes. Here's the post she mentioned: https://www.instagram.com/p/CcQuULsOABh/

A screen shot of an Instagram post celebrating patient discharge. The IG caption reads "The best and saddest day EVER. . On the difficult days, we pause and look back at how far they’ve come before we move forward again. . Then they’re ready and we GO at those challenges head on. . Until we make it to the end of our time together. They no longer need me. 🥲"

Mimi Hayes Kick Starter

Mimi Hays survived a stroke shortly into her first job as a teacher in her twenties. She had a ridiculous amount of trouble getting treatment which still makes me angry. So naturally, she turned to a career in comedy, and she's a delight. We talked all about her adventures here: http://Strokecast.com//mimi

Mimi has performed all sorts of places, including the massive Edinburgh Fringe Festival in Scotland. Now she's trying to get back to Fringe and has launched a KickStarter to do that. It's open until July 9, 2022.

Check it out here, and follow Mimi on social for fabulous minutes throughout the day.

Hacks of the Week

Michelle had three different hacks to share with us this week

First, don't isolate yourself. You don't have to do recovery alone. From the therapists to the doctors to the other patients to family and friends, there are people who want to be there on the journey with you. Let them, and invite them.

I always say the stroke club is full of cool kids. But the dues really suck!

Second, find therapy in everyday life. Whether that's trying to use an affected hand to turn on a light or finding reason to speak just a few more words, the therapy that really matters isn't taking place on a mat table (though that helps). It's taking place when you do or attempt to do the tasks in life that have the potential to bring you joy.

Third, don't guess. Dutch Test. To understand what is going on with your hormones, start by knowing what those levels are. Then you and your medical team can discuss the lifestyle changes that can be most helpful.


Where do we go from here?

Here is the latest episode of The Strokecast


The Stroke Artist: A Tale of Survival, Painting, and Urology

Often we tend to think of "patients" and "providers." While sometime we may accuse medical teams of forgetting that their patients are whole human beings and not just a wrist band and chart in a hospital bed, it works the other way, too. We sometimes forget that our doctors are more than white coats adjusting out medications and asking who the president is -- again.

But doctors are, in fact, human. And they can create art. And they can have strokes.

Dr. Bevan Choate, MD, was a surgeon and urologist just enter the heart (or kidney) of his career. One morning, everything changed. He shares his story of the past 18 month in this episode.

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


Who is Dr. Bevan Choate, MD?

A gray scale headshot of Dr. Bevan Choate from the neck up. His face fills the frame.

Bevan was bornin 1985 in San Angelo, TX.  What do you do when you are born in San Angelo, TX? You grow up on a horse. As Bevan says:

"I grew up in a cattle ranching family.  Cowboying since I could ride a horse but perhaps due to the Waylon and Willie song, they didn’t want me to grow up to be a cowboy. So, I was given all the odd and less glamorous jobs.


I realized about midway through undergrad that I wanted to be a doctor.  I was always a science geek at heart, and figured medicine to be a pure and noble application of science.

I excelled in medical school and completed my five-year Urology residency in Albuquerque at the University of New Mexico Hospital.  It was the roughest five years of my entire life.  Being a sleepless subordinate for almost two thousand days is a tough pill to swallow.  Nonetheless, I persevered and began practicing Urology in Albuquerque.  It was my calling.  I love it.  I love my patients and some of them even love me.  I did quite a bit of oncologic surgery and got good at robotic surgery using the Da Vinci robot. "

Things changed for Bevan on December 3, 2020. That's when a left vertebral artery dissection threw a clot that lodged in the left part of his cerebellar and proceeded to kill millions of valuable brain cells.

The dissection has no "attributable etiology." That's how doctors write a shoulder shrug emoji. No one knows why it happened. Bevan just got lucky.

The surgeons who were not Bevan got to work. His procedures included a ventricular shunt, a craniectomy, and a left cerebellar strokectomy (surgical excision of infarcted brain tissue post-stroke with preservation of skull integrity, distinguishing it from decompressive hemicraniectomy).

As Bevan says, "Yep, I have about 80-85% of a brain.  Not playing with a full deck"

Following this adventure, Bevan contended with:

  • Acute Deficits
    • Double vision
    • Visual impairment
    • Vertigo
    • Left-sided ataxia
    • Loss of left fine motor function
    • Inability to walk or balance
  • Chronic Deficits
    • Loss of left fine motor function
    • Balance issues
    • Right sided stroke neuropathy
    • Left-sided ataxia

Since then, he's accomplished some impressive things, not the least of which are living and walking. He's also become a published author and a professional artist.

He's also still practicing medicine and seeing patients. The laser may need to wait a little while though.

It's been quite the year and a half.

Typing around a Stroke

People approach their stroke recovery in different ways. Bevan and Michael Schutt both launched their writing projects to learn to type with their affected side again.

My approach to typing was the opposite. Instead of forcing my left hand to the keyboard, I wanted to get faster more quickly. I taught myself to type more quickly with one hand. I'm currently at about 34 wpm (average for two-handed typists is about 44 wpm).

Has that slowed my recovery? Maybe. Recovery is a delicate balance of accepting a disability and fighting that disability. Too far in one direction is not great for living the best life possible for many folks.

Of course, every stroke is different. I can admire the approach others took without feeling mine was wrong. Especially since my fingers are still (slowly) coming back.

And if they don't, that's fine, too.

Why write?

Bevan started writing his book to collect anecdotes. It's so easy to forget the details of an event with time, especially if we don't realize at the moment how important they might be. The very acting of writing or typing them out gives them a stronger hold in our memory. Every time we read them again, we can reinforce that hold they have. We can extract more incite from them.

You don't have to write a book, though. When I was in the hospital, I tried to post at least one anecdote from the day every day to Facebook. Part of that was to keep people informed of my status. Part was my compulsion to entertain folks and make sure they got value from check in on me (that's something I should probably unpack at some point). Part of it was to chronicle what I was going through for future reference.

In Bevan's case, doing that led to "The Stroke Artist."* It's his memoir of his stroke experience as a doctor who returns to the art he enjoyed, then made it a second profession. The varied paths stroke take us on never cease to amaze.

You can find Bevan's book on Amazon here. *

So write down your stories. Maybe it's just a collection of random anecdotes and paragraphs without a plan. Maybe it's all jumbled in time. If you can physically write, record video or audio. Or take pictures. Or tell your stories to someone else.

The stories we tell connect us with the world across the ages, going both backwards and forwards in time.

As the 11th Doctor said, "We're all stories in the end."

Bevan's Art

Bevan started creating art just to create art. That's probably the best reason to do it.

When I started blogging in 2006, it was because I realized I hadn't written anything that wasn't an email or a PowerPoint slide in years and I needed to write for the sake of writing. Of course, that set me on the path to where I am today, but that's not really the point I'm trying to make here.

Bevan returned to art after stroke and before long, he was selling art online. You can browse his work and even make a purchase at his website. You can find that here.

n abstract palette knife painting by Stroke Artist Dr Bevan Choate named Studlagilhttps://artrepreneur.com/showroom/q3GhqiFsYA2jL75iy

The relationship between stroke and art is fascinating. It gets into the physical changes in the brain brought on by stroke, the lifestyle changes we are forced to make, and the shift in our own priorities and world view after stroke. Bevan and I talked about some of that in our conversation. If you found that discussion interesting, I'd also encourage you to listen to my conversation with Seattle artist and survivor Seth Ian Scheer from 2019.

Stroke Strides Support Group

The Stroke Strides support group is a virtual group, based at Multicare Good Samaritan Hospital in Western Washington. They are looking for survivors who would like to speak to their group individually or as part of a panel. If you are looking for channels to share your story, this is a nice one. The last time I did it the group was fairly small, which means it's great if you want to get started speaking to other groups.

They are starting up their next series of talks in July 2022, and I'll be part of that. If you'd like to join as well, reach out to Kristin Olson (ktolson@multicare.org) for more details.

Hack of the Week

Big goals can be inspiring, but they can also be hard to achieve. To really kick start your recovery, set small, simple goals. Work towards small improvements. Those small goals and habits over time add up to big things. That's how you ultimately achieve success.

Bevan's hack align nicely with my regular mantra: Don't get best…get better.


Where do we go from here?

Here is the latest episode of The Strokecast


5th Strokeaversary

June 3, 2022, was my fifth Strokeaversary.

It's an important milestone. My risk for a second stroke is now statistically lower, but that not why this matters. It's not about celebrating experiencing a stroke. It celebrating survival and recovery. It's about coming back from a battle with my own blood vessels both damaged and enriched.

It's complicated. But that blood clot on the morning of June 3, 2017, changed the direction of my life for good.

In this solo episode I share some more thoughts and feelings about my experience.

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


Don't get best…get better

I end every episode and nearly every blog post with this line, but what does it mean?

It means that constantly trying to be the best is a flawed path. To be the best at something means that everyone else has to be worse. It is an approach that actively discourages people from working together to help one another. The experiences of these past few years show us just how much we do need to work together and support one another.

Instead of focusing on being the best, focusing on just being a tiny bit better every day. Make the effort to consistently improve just a tiny bit. Help others to improve just a tiny bit, too.

Those little bits of improvement -- of growth -- add up over the days, weeks, months, and years. It can take you so much further that just focusing on the win/lose yes/so succeed/fail dichotomy that a focus on being the best promotes.

Where is my recovery today?

My recovery is ongoing. It didn't stop at the 6 month mark. Or the 12 month mark. Or the 24 month mark. Recovery doesn't stop on some artificial timeline.

My fingers are still getting better. I'd say I have about 15% of the use of my left hand back at this point. I can use it for practical stuff. Not in the same way I did before the stroke of course, but it will get there given enough time and work.

Right now my legs are tired because of an unplanned Costco shopping excursion where they were out of electric mobility carts. And since it was unplanned, I didn't wear my AFO so it was a lot more work. But I did it. And I wouldn't have been able to 3 years ago.

I also recently got my latest thrice yearly Dysport injection (a BOTOX alternative) . This medication treats the tone and spasticity in my left arm. My doctor was able to use less this time and treat fewer muscles. Again, it's another example of progress.

It's not all perfect, of course. I'm still living with fatigue, exacerbated by my recent COVID experience. So that's fun. And it's part of the reason I'm getting this episode out a week later than I had planned.  Adapting is what we do, though.

Going forward

I still have lots of projects to pursue as I go forward. I'm working on a book right now. Actually, I've been working on it for a year and a half and had to start over somewhere in the middle. I look forward to sharing more details on that later in the year.

I've also been doing more talks with survivor groups, students, and more to share my story and to help others share their stories. I plan to do more of that in the coming year. If you're looking for a speaker for your support group, reach out and let me know.


That brings me to the importance of storytelling. It's a theme that comes up again and again in my work. Professionally, I help journalists use Microsoft tools to tell stories more efficiently. I tell stories as part of that training process. Strokecast itself is built around empowering survivors and professionals tell their stories to educate and encourage the entire stroke community. Those stories help build connections across the silos of expertise and experience we find ourselves living in.

In sales and marketing, we say, "Facts tell; stories sell." Talking about stroke isn’t just about drilling into the biological details (though that is important). It's about telling the stories of real people or processes to connect those facts the lived experience we have. It's about helping patients, doctors, researchers, therapists, and commercial partners all experience one another as real people instead of just a bullet point list of details.

People don't want to go to a lecture on facts. They do want to go hear someone's story. That's how people connect with material.

Our earliest cultural touchstones in Western Civilization are based around storytelling -- from the ancient greek mythology to the slightly less ancient Homeric tales to the Christian bible where Jesus instructs his followers not with just precepts, but with parables -- stories -- that make the point.

The Brothers Grimm didn't just make a list of rules for safety and moral codes. The collected, recorded, and refined the fairy tales to serve as warnings to children about the dangers of the world.

My story and your story are how we can talk about stroke with others. That we can explain what it is, what to do, how to spot it, and potentially, how to avoid it. And even more importantly, that stroke and brain injury doesn't need to be an end. It can be a change -- a new beginning to a new phase in life. We may lose somethings while we gain so many more.

Was stroke a blessing or a curse?

I ask this question of most of my guests because it's one I struggle with myself. Most of my guests say it was a blessing. I'm not so sure.

For my detailed thought process on this question, though, I encourage to you listen to the episode or check out the transcript.

How can you support me?

There are a few things you can do to support me and the Strokecast. These are all things that help to grow the platform so more people can experience that value that you experience. Growing the platform will be a big help to me.

First, tell people about the show or tell them about your favorite episodes. The single best way to get more people to listen to a podcast is word of mouth from trusted friends and colleagues. They can find it in their favorite app, or they can just go to http://Strokecast.com

Second, subscribe to the Strokecast newsletter so you get updates and news when I'm able to share them via email.

Third, follow me on Instagram where I am @Bills_Strokecast. I post a lot of quotes from previous episodes and a few personal updates.

Fourth, invite me to speak to your virtual or local stroke support group. My webcam is always ready. Or hire me to speak at your conference or professional event/meeting. Just email me at Bill@Strokecast.com

Hack of the Week

When it's time to shop for a new mobile phone, look for one with a screen size of 5.5" or smaller. They're getting tough to find.

If you have only one functioning hand a larger screen is much harder to use. You have to be able to hold it in your hand and reach all the important stuff on the screen with just your thumb. If you can’t reach something on the screen it's quite frustrating, and it increases the odds you'll drop your phone.


Where do we go from here?

Here is the latest episode of The Strokecast