A Stroke Survivor Rediscovers all the Love in his Life

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Success after stroke relies a lot on community. That's the case with today's guest Hub Miller. It's a story of knowing the FAST/BEFAST warning  signs of stroke because people talk about it. And it's a story of going through the worst moments of your life only to find yourself surrounded by loving family members and friends ready to share their strength with you.

You can listen to Hub's story here.

If you don't see the audio player, click here to listen to the conversation.

 

Click here for a machine-generated transcript

Who is Hub Miller?

Hub graduated from Mississippi State University with an MS in Agronomy in 2005. Since then, he's built a career in agricultural science, helping farmers produce bigger and more reliable crops.

Throughout the years, he's worked for an assortment of high tech agriculture companies, including, Dow Agrosciences, Corteva Agriscience, and Miller Entomological Service. In January of 2023, Hub took a new role as Vice President of Teleos Ag Solutions

In the Spring of 2021, Hub experienced a massive stroke brought on by high blood pressure. With the support of his family and friend, he's staged an amazing comeback.

You can connect with Hub via LinkedIn.

BE FAST

Speed is essential to reducing long-term disability after stroke. That's why it is so important to spot the signs. The BE FAST acronym can help you spot most stroke.

A person may be experiencing a stroke if they have:

B – a sudden loss of or change in balance

E – a sudden change in or loss of eyesight or vision

F – single side face droop

A – in ability to hold both arms up

S – loss of or change in speech, vocabulary, or ability to process language

T – Any of this means it is time to call an ambulance

BE FAST = Balance, Eyes, Face, Arms, Speech, Time to call an ambulance.

Down load this graphic and share it with everyone you know.

If you know people who speak Spanish, Dr. Remle Crowe helped develop an equivalent acronym in Spanish -- AHORA.

Let’s look at a translation.

Letter	Abbreviation for	Spanish Description	In English
A	Andar	Tiene dificultad para andar? Tiene problemas con el equilibrio?	Do they have difficulty walking? Do they have problems with balance?
H	Hablar	Tiene dificultad para hablar o entender? Usa palabras que no tienen sentido?	Do they have difficulty speaking or understanding language? Do they use words that don’t make sense?
O	Ojos	Tiene algün cambio de vista? Tiene visiön doble? Tiene dificultad para ver con ambos ojos?	Do they have some change in vision? Do they have double vision? Do they have difficulty seeing with both eyes?
R	Rostro	Tiene la mitad del rostro caido? Tiene un repentino dolor de cabeza como nunca se ha sentido?	Do they have one-sided facial droop? Do they suddenly have the worst headache of their life?
A	Ambos Brazos	Tiene dificultad para levantar un brazo o una pierna? Tiene debilidad en un brazo o una pierna?	Do they have difficulty lifting an arm or a leg? Do they have weakness in an rm or a leg?

High Blood Pressure

One of the main causes of stroke is high blood pressure. It's a topic we discuss a lot. It caused Hub's stroke, and it caused my stroke.

The American Heart Association recommends a blood pressure of 120/80. Inexpensive blood pressure monitors are available online. Check yours and speak with your doctor if you are not in the target range. 

I talked about how high blood pressure causes stroke with Neuro-interventionist and surgeon Dr. Nirav H. Shaw in this episode: https://strokecast.com/bloodpressure

If you don't have a home blood pressure meter, you should probably fix that. You can find them at your local pharmacy, Costco, large grocery store, and on Amazon at this link.*

Survey

Do you have thoughts about the Strokecast as a show? I want to hear about it. Please complete the listener survey at http://Strokecast.com/survey by March 31, 2023 to share your insight. I'd realy appreciate it.

Hack of the Week

Hub recommends yoga. Yoga has strong meditative qualities, and he has found it helpful in his recovery.

Yoga and meditation are themes that come up from lots of guests. Breathing, movement, stretches, and focusing the mind can help quite the noise of the outside world and service our bodies as the brain relearns how to operate our limbs.

Around the country and around the world, we are seeing more opportunities for disabled yoga or chair yoga. Practitioners are modifying positions and techniques so folks with physical limitations can still safely reap the benefits of this ancient tradition. Look around your community for disability-friendly yoga if the idea appeals to you.

And speaking of community, Hub has also found a lot of value in local stroke support groups. These groups give folks an opportunity to connect in person or online and share experiences, stories, and local resources to provide a much needed connection.

Links

 

[wptb id=4311]

Where do we go from here?

• Connect with Hub on LinkedIn here
• Share this episode with someone you know by giving them the link http://Strokecast.com/Hub
• Complete the Strokecast listener survey at http://Strokecast.com/Survey
• Don't get best…get better

More thoughts from Hub

Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub Hub Miller had a stroke while working from home, and he knew what to do. Eighteen months later he is back to driving and back at work. In this conversation he tells us about it and the importance of community support. Learn more at http://Strokecast.com/Hub

Here is the latest episode of The Strokecast

Tone and Spasticity after Stroke with Dr. Wayne Feng

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Stroke survivors with physical deficits have to fight to get the muscles moving again. They also have to fight to stop some muscles from moving.

Tone and spasticity are why our elbows curl, our fists squeeze tight, and our toes can curl under our feet so we crush our own toes as we walk.

Dr. Wayne Feng is an expert in tone and spasticity after stroke and he joins us this week to explain how we can address these challenges

If you don't see the audio player below, visit Strokecast.com/MSN/ToneBasics to listen to the conversation.

 

Click here for a machine-generated transcript

Who is Dr. Wayne Feng?

From Dr. Feng's Duke Profile:

I am the division chief for Stroke and Vascular Neurology in the Department of Neurology at Duke Health. I see stroke patient in the emergency department, inpatient service as well as in the outpatient clinic. I also treated post-stroke limb spasticity, a disabling complication after stroke. In addition to the patient care, I also run a brain modulation and stroke recovery lab at the Duke University campus to study stroke patients in my lab to develop new stroke recovery therapy. On my days off, my boys and I are big on fishing. I enjoy drinking and collecting tea. As a stroke doctor, I do not drink coffee at all (there is a reason for it). If you come to see, I will tell you.

Current Appointments and Affiliations:

• Professor of Neurology, Neurology, Stroke and Vascular Neurology 2019
• Chief of Stroke & Vascular Neurology in the Department of Neurology, Neurology, Stroke and Vascular Neurology 2019
• Professor of Biomedical Engineering, Biomedical Engineering 2022

[youtube https://www.youtube.com/watch?v=SGeOGI2bry4&w=560&h=315]

Tone and Spasticity Overview

Mos of our limbs move because of the interaction between two types of muscles -- extensors and flexors.

The flexors contract to bend a limb. The extensors contract to extend the limb. For example, the biceps are flexors. They pull our forearm up or into an angle. When people want to show off their arm muscle, the flex their arm -- they activate their flexors.

The triceps on the back of the upper arm are extensors. When they activate, they extend the arm -- they pull the arm straight.  When flexors contract extensors relax. When extensors contract, flexors relax. That's how we control our limbs.

After stroke, the flexors can activate on their own. And they can be, well, overenthusiastic, in those actions.

That happens because the default behavior of the flexors is to be active and curl up. When we talk about curling up into the fetal position, that's most of our flexors activating.

The reason we can go through life upright and with our limbs straight is that the cortex of the waking brain is constantly suppressing the normal contracting of the flexors.

After stroke impacting the motor cortex of the brain, the corticospinal tract is disconnected. With that disconnect, the brain can no longer suppress the flexors so they do what they do -- they contract and curl and cause all sorts of problems.

Peripheral vs Cortical Problems

Categorizing issues as cortical or peripheral is a fancy way of saying brain or limb.

A stroke is a cortical issue. The problem exists in the brain. That's where the disconnect happens.

A peripheral issue is when something goes wrong in the limb. Shoulder subluxation, for example, is peripheral issue.

Most PT and OT works with the limbs to treat the cortical issues. Tone and spasticity are caused by cortical issues.

The long-term problems caused by tone and spasticity are peripheral issues.

One of those peripheral issues is contracture. When tone and spasticity is severe and long term, the muscles, tendons, ligaments, and other soft tissue can actually shrink in the contracted position. When that happens, getting the extensors back online and suppressing the flexors no longer  helps. The limb can become almost permanently bent.

Repairing peripheral issues, like contracture, may require surgery to sever and extend tendons and other tissue.

Preventing and Treating Tone and Spasticity

The first line of defense is in the immediate short-term after stroke. Getting the limbs moving and keeping them moving to drive the neuroplastic change of recovery helps.

Beyond that, and once tone and spasticity set in, regular stretching is critical. A survivor needs to keep stretching those limbs to prevent contracture.

That's why in conference calls and interviews, I'm often stretching my fingers back and my wrist back to counteract the tone and spasticity in my left arm and hand.

Medication can help, too. Baclofen is a popular choice. It's basically a muscle relaxer that helps counteract the excessive action in my flexors. Some people find it can cause drowsiness so it's not the best choice for everyone.

I tend to take my Baclofen before going to bed. If it makes me drowsy then that's great. It also helps reduce the tone I might experience overnight.

For folks with severe tone and spasticity, a surgically implanted Baclofen pump can help. The medicine directly target the key muscles which means the patient needs much less medicine for a much greater impact. Since it is a low dose, it is less likely to induce the fatigue, too.

Other medications to treat tone and spasticity include:

• Tizanidine
• Flexeril
• Gabapentin

Botox, Dysport, and Xeomin are also treatments that can help. These are neurotoxins that a doctor can inject every three to four months. By delivering the toxins to the flexors, it reduces their ability to flex. That gives the extensors a chance to recover and rebuild a normal relationship. Of course, this is a short-term solution. Combined with exercise, it can definitely help.

I'm probably overdue for my next Dysport treatment.

Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

A promising area for relieving tone and spasticity is C7 nerve transfer. Recent studies are showing promising results.

Neurosurgeons split the a nerve from the unaffected side of the brain that runs through the spine and reconnect half of it to the equivalent nerve on the affected side. The do this in the neck.

Results show a quick reduction in tone and spasticity even in patients 15+ years after stroke. After a year, patients are experiencing improved use of the limb, too.

The number of people in the studies so far is pretty small (36) and more research is needed. It is a promising result, though, and builds on techniques that have been used to treat non-stroke injuries.

It also highlights the tremendous ability of the brain to adapt since now the unaffected side starts to control the affected side of the body.

You can read a review of the technique and studies at the Journal of Clinical Medicine.

Vagus Nerve Stimulation

In 2021, I spoke with Dr. Jesse Dawson, a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital in Scotland about his research in Vagus Nerve Stimulation. This research is now being commercialized and used to treat patients in the US.

The therapy involves surgically implanting a stimulator in a patient's chest that connects to the Vagus nerve. During PT or other exercises, the device sends an electric signal to the Vagus nerve. Stimulating the nerve while doing therapy has shown positive results in terms of limb use.

It's interesting because it's not treating the Vagus nerve itself, but stimulating this nerve appears to make the other nerves in the brain more receptive to the therapeutic exercises.

You can learn more about this research here: http://Strokecast.com/VNS.

Survey

What do you think of the Strokecast? Let me know what you like and what you would like to be different by completing the survey at http://Strokecast.com/Survey. I would really appreciate it.

If you complete the survey by March 31, 2023, you could win a $25 Amazon gift card, too.

Hack of the Week

Hand grip exercisers are nice tools to encourage stretching and exercise throughout the day.

These things are like a pair of pliers without the tool end. They are spring loaded. You squeeze them to exercise and they try to force your hand open. You can get them in a variety of strength levels. Start with light weight ones and move on to tougher ones as your strength improves.

What I like about them is that closing a fist comes back before opening one. Closing your fist takes work. Opening your fist is often harder, but these gadgets force the hand open. So you get to practice the squeeze and you get a stretch into fingers, too, to address tone and spasticity.

It's also one more way to reduce the odds of developing a contracture.

Here are a couple options:

https://strokecast.com/Hack/HandExerciserTraditional (Traditional design)*

https://strokecast.com/Hack/HandExerciserAdjustable (Adjustable resistance)*

Links

Where do we go from here?

• Check out Dr. Feng's work at Duke University
• Share this episode with someone you know by giving them the link http://Strokecast.com/ToneBasics
• Complete the Strokecast survey at http://Strokecast.com/Survey
• Don't get best…get better

More thoughts on Tone and Spasticity

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Tone and spasticity after stroke is super common among stroke survivors with physical deficits. But what is it? And how can survivors manage it and prevent permanent damage? Dr. Wayne Feng from Duke University takes through the basics in this conversation at http://Strokecast.com/ToneBasics

Here is the latest episode of The Strokecast

5 Ways to get the most out of the new year for stroke survivors

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Whether you're celebrating the new year on January 1, January 22, September 15, your birthday, your Strokeaversary, or some other date in 2023 or beyond, it's a time to pause and think about where you want to go and what you want to do.

We could talk about resolutions, but that seems to set us up for failure. Few people set and achieve resolutions. Failing them within 2 weeks of the new year is pretty much a comedy trope at this point. So with all that cultural baggage, let's not talk about resolutions.

Let's talk things we can do. Here are 5 things you can build into your plan for the new year.

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

 

Click here for a machine-generated transcript

Decide what you want

Many people go through life on autopilot; they let the things they want be decided by societal standards or other people or their perceptions of what they're supposed to want.

Others choose goals, priorities, and direction once and never think about it again.

Stroke adds yet another layer to that. Most stroke survivors I speak with say the stroke changed not only their abilities but also the way the think about life. It adjusts their priorities or brings a level of clarity they might not have had before.

Whether you thought you knew what you wanted before a stroke or not, surviving a stroke gives you a reason to stop.

To stop and think about your goals.

It gives you a chance to think about what you really want now.

That doesn't mean you have to scale back because of language, physical, cognitive or other disabilities. It's possible your dreams now can be even bigger.

What it does mean is you have some work to do. You have to figure out what you want to do and why you want to do it.

Before you pursue a goal or plan of action for your new year, decide if you want the result. Maybe running seems like something you SHOULD do, but do you really want to? You're unlikely to be successful at achieving a goal you don't care about.

Take some time and a pen and paper or blank digital document or dry erase board or a partner who can serve as a scribe, and make a list of things you care about and want to do. What are you passionate about? What do you care about? What lights a fire under you?

After stroke your answer may be wildly different than it was before.

If the answer is "nothing," that's okay, too. Perhaps dedicate your year to finding something you care about. Or find a counselor you can  communicate with. Lack of interest in things could be a sign of depression.

In my experience, many people don't know what they really care about or want to do because they haven't taken the time to figure it out. The run on autopilot doing what they think they are "supposed to do" rather than what truly inspires their soul.

So think about what you want and then decide to pursue it.

Make a plan

Once you know what you want to do, then you can figure out how to do it. Talk to people who can help. Maybe that means getting more PT, OT, or speech therapy. Maybe it means finding a business or writing coach. Maybe it means more work by yourself at home.

You don't have to get it all at once. Break it up into smaller pieces and work on a plan to complete these individual pieces.

One method that helps it to build SMART goal. These are goals that are Simple, Measurable, Achievable, Relevant, and Time bound. I talked more about SMART goals in an earlier episode at http://Strokecast.com/SMART.

Find a community

Loneliness and isolation are two if the biggest non-medical challenges stroke survivors face. It may seem even harder for younger stroke survivors who suddenly find themselves flung off the traditional life paths of advancement their peers are on.

So find a community of stroke and brain injury survivors. We're out there.

Look for local support groups. Many are meeting online these days. Try different groups until you find one you feel comfortable it. Afterall, each group develops its own personality. Some will be mainly social while others will focus more on education. Some will be more diverse while others may be made primarily of older folks. If you're not comfortable in one group, try another.

Check out the various Stroke hashtags on Instagram, Twitter, and Tik Tok. Follow and interact with folks using tags like:

• #Stroke
• #StrokeSurvivor
• #StrokeLife
• #StrokeAwareness
• #StrokeRecovery

Try some others that you come up with. Watch the content. Like and comment on it. Share your favorites.

Share your story

All those stroke stories that you've found helpful? They were told by someone who thought their own story was boring and not worth telling. Many people can't imagine how their experience can help others.

So consider telling your story. That doesn't mean you need to start a podcast or YouTube channel (but let me know if you do). Just work on becoming comfortable telling it to other survivors and your family members and friends.

If you have a forum to tell your story, tell it. Maybe it will help another survivor feel not so alone. Or it will help your colleagues understand other folks in their own family or social circle. Maybe a stranger will learn the BEFAST warning signs, and that will make all the difference in someone else's stroke.

At the very least, it may help you better understand and make peace with your own experience.

As a species, we thrive on storytelling. And you have a doozy to share.

Reach out to your therapists

If it's been a while since you were in contact with your medical team or you ended therapy for whatever reason, reach out to your former PTs, OT, SLPs, Doctors, etc. Let them know how you’re doing and share your progress.

If you can't visit the medical facility, send them an email, or send a note or card to the facility.

They work hard to get us to the next level, but they don't see most of us after that. Most of them love it when former patients send them an update or reach out to them.

They helped us so much. This is an easy, cheap, and powerful way to help them.

Have a great new year

This new year, whenever you mark it, is yours to decide what to do with. I know, that's easy to say and sometimes it's harder to see it. But the time is going to pass regardless of what you choose to do.

Take this moment and make some decisions. Do the things you can do to influence the outcome of your future. Whatever your goal is, you won't get any closer to it unless you know what it is and take active steps to get there.

Survey

As we head into the new year, I want to hear from you about how I can make this show better. Or to keep it the same if you like it the way it is. Visit http://Strokecast.com/Survey to fill out the short form and share your thoughts. You can do so anonymously. If you'd like to shed a little anonymity, you can enter a drawing for a $25 Amazon gift card. For more details and to complete the survey, please visit http://Strokecast.com/Survey.

Win of the Week

If you had an accomplishment or win, big or small since your stroke, the community wants to hear about it. Visit http://Strokecast.com/Win to learn how you can share it so we can all celebrate.

Hack of the Week

If you pour liquor from bottles, look for 1 ounce or 1.5 ounce pour stoppers like these on Amazon: http://Strokecast.com/Hack/Stopper. * I found some that I use at Total Wine so they're readily available.

I enjoy nice whiskey, Scotch, and bourbon in moderation (my doctor said, "Just don't drown your brain in it." The problem I have with the bottles comes from my hemiparesis.

Pulling the lid/cork from the bottle means holding the bottle in place. I have to count on my weaker and spastic arm to hold the bottle still while I remove the lid with my other hand. And then I have to rely on my affected arm to not jerk and spill the bottle the instant the lid pops free. Putting the cork/top back in is easier, but still presents similar challenges. So let's reduce the risk of spill.

These pourers mean that I have to only pop the lid off once, and then put the pourer in. Over the course of the next several months when I want to sip a dram, I just pick up the bottle and pour.

The bonus perk here is that I know exactly how much I'm pouring -- no accidental overpours.

If you have non-alcohol bottle, like flavorings for coffee or olive oil, you may want to take a look at these stoppers, too. The texture of the liquid may be an issue, but look into it to figure out what works for you.

Links

Where do we go from here?

• As you start your new year, whenever it starts, do the 5 things we talked about here:
  • Decide what you want
  • Make a plan, Find a community
  • Share your story
  • Contact your therapists

• Share this guide with someone you know by giving them the link http://Strokecast.com/NewYear
• Visit http://Strokecast.com/Win to share your win
• Don't get best…get better.

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

1) Decide what you want

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

2) Make a plan

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

3) Find a community

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

4) Share your story

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

5) Contact your therapists

There are 5 things stroke survivors can do to have a great new year. I discuss them at http://Strokecast.com/NewYear

Here is the latest episode of The Strokecast