2022-09-22

Use Robots and Ultrasound to Treat and Prevent Stroke


To effectively treat stroke and prevent stroke, you need to know just what is literally happening in a patient's head. CT Scans and MRI scans are tools most of us are familiar with. Generally if you suspect a stroke is possible, you need these two scans done.

There's another tool out there, too, that's cheaper, more portable, and involves no radiation. It's called Transcranial Doppler Ultrasound. It's a great complement to the other scans, and it can provide impressive insight to supplement the information from the radiologists. A skilled practitioner is a great complement to the care team.

I first talked about this technology in my conversation with Dr. Aaron Stayman a few years back (Is my Brain Pregnant? Ultrasound and Stroke: Transcranial Doppler Ultrasound). It's fascinating stuff.

The problem is that it does require a skilled technician or someone specifically trained in the technique. Despite the work of advocates like Dr. Stayman and Dr. Mar Rubin, there just aren't enough of those techs.

Dr. Mark Hamilton of Nova Signal has a solution. His robotic machine automates the whole process, makes it faster, more reliable, and cheaper while giving more accurate results in a lot of scenarios. The Nova Signal solution has the potential to make this technology available to patients and medical practitioners around the world.

Drs. Rubin and Hamilton join me in this episode to discuss the technology, the research, and the device itself.

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

 

Click here for a machine-generated transcript

Who are Drs. Rubin and Hamilton?

Dr. mark Rubin wears a suit and tie and faces the camera in this professional headshot in a library

Dr. Mark N. Rubin is a vascular neurologist and associate professor of neurology with the University of Tennessee Health Science Center Department of Neurology. He specializes in vascular neurology and is experienced in stroke and cerebrovascular disease, and an experienced sonographer and expert interpreter of carotid duplex ultrasound and transcranial Doppler ultrasonography.

He received his medical degree from University of Illinois College of Medicine and completed his Adult Neurology residency and fellowships (Neurohospitalist and Vascular Neurology) at the Mayo Clinic.

Dr. Robert Hamilton is outside in front of a tree wearing a light blue button down shirt with an open collar

Robert Hamilton, Ph.D. is the Chief Scientific Officer and Co-Founder of NovaSignal. He is an accomplished entrepreneur, engineer, and clinical researcher with a passion for innovative technologies that allow for increased access to care.

Robert, a biomedical engineer by training, is an expert in image/signal processing and machine learning, with extensive experience in cerebral blood flow, traumatic brain injury, stroke, and other neurological disorders. Robert co-founded NovaSignal based on technology he developed during his Ph.D.

During his tenure at the company, Robert has supported the entire lifecycle of the NovaSignal autonomous ultrasound platform from idea to commercialization with regulatory clearances in the US, Europe, and Canada. Additionally, Robert has designed and completed several clinical trials supporting the use of the technology in different neurological conditions and has acted as principal investigator on federal grants and contracts totaling more than $25M from the Department of Defense, National Institutes of Health, and the National Science Foundation. 

Finally, Robert has achieved greater than 100 citations of his work in peer-reviewed publications and conferences and holds over 50 patent assets related to the core technology developed during his PhD studies.

TCD vs Traditional Ultrasound

When most of us think of ultrasound in medicine, we think of the sonograms of developing children, where parents and doctors swear they can see a human being in those black and white lines. Personally, they seem more like those Magic Eye pictures from the 90s.

Traditional ultrasound can also capture pictures of the heart, the blood vessels in the neck, and the condition of other organs in the body. It can be another way of getting a picture of the structures at play.

And then you can frame those pictures or make them your Facebook profile picture.

TCD is different. The goal is not to capture a picture of the structures of the brain. The goal instead is to understand blood flow through the brain. The technology helps practitioners understand the rate of flow, where there may be leaks or disruptions, if stuff is flowing with the blood that shouldn't, the direction of flow, and whether things are shunting (or crossing) between the veins and arteries that shouldn't.

That shunting is at the core of the recent study Nova Signal was part of and that we talk about in this conversation.

There are several reasons shunting can occur, but one of the most common is a PFO, or a hole in the heart. I talked in more detail about just what a PFO is in the last episode here: http://Strokecast.com/Anna

TCD is a great technology for helping doctors understand the dynamic flow of blood in each individual patient. And it doesn't involve the dedicated rooms or radiation that might come with CT  or MRI Scans.

NovaGuide™ 2 Intelligent Ultrasound

The Nova Guide 2 Intelligent Ultrasound is the device we talked about in this conversation.

While TCD is a great tool, it does take a while to get the scan just right, and we face a dearth of practitioners who are able to do it.

The Nova Signal solution is simpler. It's small and automated. The device can orient itself and complete a scan much quicker than a human can. The research shows it's more accurate, too.

It doesn't take up much space in a medical facility and can easily be brought from one patient to another. Plus, an operator can perform a lot more scans per hour or get back to other tasks more quickly. With hospitals perpetually understaffed these days, that speed makes a lot of financial sense.

And since, in stroke, time is brain, it can make a lot of medical sense, too.

Nova Signal vs Transthoracic Echocardiography

The information about the presentation at the International Stroke conference is here: https://eventpilotadmin.com/web/page.php?page=IntHtml&project=ISC22&id=1176

This is the data we talked about a lot in the conversation. The Nova Signal device was significantly better at detecting the vein-artery shunts indicative of PFO and other conditions than the gold-standard  evaluation technique using Transthoracic Echocardiogram.

This matters in stroke because when we talk about shunting in tests we're usually talking about very small bubbles. Outside of the test context we're usually talking about clots and other stuff sneaking across from veins to arteries, bypassing the body's filters. When they do that they can go to the brain and cause a stroke.

Accurate detection of shunting allows physicians to make more appropriate treatment recommendations and decisions.

Hack of the Week

Cultivating a sense of gratitude, as unlikely as it may seem, is something that helps a lot of folks deal with the challenges pf post stroke life. Simply being alive means thing can get better. And being alive in the 21 century with the medical resources available is a huge asset to the community.

Of course those medical resources are not evenly distributed within the US and around the world, but they exist, and that's a start.

Develop a sense of purpose. After stroke, it can be hard to see a way forward, especially if you have severe disabilities. People who succeed in their recovery, or in their goals in general, typically have a pretty strong "Why?" driving them. Achieving their goals gets them closer to something important to them.

In the dark times, when you find yourself feeling it's just not worth it, your why -- your sense of purpose can give you a reason to push through.

We sometimes ask, "Why should I go on?" almost rhetorically to express or pain. For some folks, though, it can be an exercise to identify the things that matter to you. So ask yourself that question, but assume there is an answer. And write down everything that could be an answer.

Cultivate the sense of purpose to get through the darkness.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:11 AM 0 comments
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2022-08-31

Yoga Teacher Finds New Life After Stroke by Going Deeper into Yoga


Anna Kerry went from yoga fan and enthusiast to Yoga teacher. Then the pandemic hit. A   year later, at age 35, she had a stroke due to as PFO.

In this episode she shares her story. She tells us how yoga got her through stroke recovery and how it informs her work today. Anna talks about the relationship between trauma and yoga, and she talks about the impact stroke has had on her life with her husband.

As Anna has gone through this journey and continued both her studies and her teaching, she developed a yoga program specifically for stroke survivors.

And Anna explores the power and near sacredness of her own yoga mat.

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

 

Click here for a machine-generated transcript

Who is Anna Kerry?

In Anna's own words:

Anna Kerry has long dark blond hair. She wears glasses and looks at the camera in this headshot

I had a stroke aged 35 in March 2021. I've had a regular yoga practice for about 10 years and decided I loved the practice so much that I wanted to learn how to teach and share my love of yoga. I qualified in Aug 2020 and had only been teaching for around 7 months when I had a stroke. As the stroke came out of the blue I had to dig deep into my yoga practice to help me through and believe that my yoga practice has helped my mindset and my mental health during this traumatic time.

I'm now in a position where I want to help other stroke survivors through their recovery so I designed The Life After Stroke Programme -- a 6 week programme designed to help stroke survivors regain their life and confidence through a holistic and embodied approach to recovery.

What is a PFO?

Anna's stroke was caused by a PFO. She found that out a month after her stroke, and she will likely get it fixed eventually.

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. Anna is waiting to get her PFO closed.

I talked about this issue in a lot more detail with Dr. David Thaler. You can listen to that conversation at http://Strokecast.com/pfo.

A Place of Her Own

Anna Kerry has a special place in this world -- it's her yoga mat.

At first glance, it's just a piece of material, but once she is on her mat it becomes a portal to take her to another special place.

The mat allows her to center herself. It's a place she can experience joy and agony; happiness and anger; tears and laughter; and everything in between. When Anna is on her mat she can take a break from the rest of the world so that she can deal with the rest of the world. It triggers a mind shift to put her in a place where she can process things and, well, do yoga.

Lots of us have things like a yoga mat. Maybe it's a special blanket or a childhood toy. Maybe it's a trinket that takes us back to a trip we took years ago or it's a gift from a lover or friend. Perhaps it’s a special chair that holds our memories of the past.

Once we touch or engage with that thing -- whatever it is -- we can feel a change in our own energy.

Is that a bit woo-woo? Not really. Perhaps it is a metaphysical portal to a different plane of time and energy.

Or perhaps it's another example of the core principle of neuroplasticity -- cell that fire together, wire together.

Our brains work on patterns and shortcuts. That's why therapy works. The more repetitions w get in PT, OT, or Speech Therapy, the more we drive new neural pathways so we can walk, speak, or bake cookies again. Repeating a process reinforces those connections until we can almost do it automatically.

A special place -- like Anna's yoga mat -- can do that, too. Sitting down on that mat can kick off those routines in the brain that shift us to a different place. The object starts the program running in our brains, and our brains do the rest.

And the really great thing about Anna's yoga mat is that when life dictates, she can roll up her special place and take it with her.

Other Yoga Themed Episodes

Teaching Yoga after a Stroke with Leslie Hadley

 Leslie Hadley went from Corporate executive to yoga teacher to stroke survivor and back to yoga teacher. Along the way she added life coach and tapping expert to her repertoire. She joins us in this episode to share her journey and explain what tapping and the Emotional Freedom technique is.

Stroke, Naps, Gratitude, and Yoga with News Anchor Kristen Aguirre

Kristen worked as a news anchor in Denver, survived a stroke, and was fired. She worked to pick up the pieces of her life, returned to the anchor desk back east and found gratitude is the key.

Win of the Week

Shelly shared her win of the week with us. You can hear it in the episode. Here's what she had to say:

My name is Shelly, and I had a stroke four months ago.

I was at the hospital for two weeks of acute rehab. I came home in a wheelchair, but I've been working really hard, and this week I did my farthest walk -- 4.2 miles.

Things are still not 100% for sure. My arm isn't working that well. I can't feel in the arm.

But the leg -- I've just been walking so much that I think things have improved. The more I've done, the more I think things improve.

I didn't understand that when I first had the stroke. In physical therapy, when they would say that I could learn to walk without feeling, but as I've done it and now people can't always tell that I had a stroke when I walk, so that's been exciting for me.

Thanks for letting us be part of your recovery, Shelly!

What is a recent win you've had?

Maybe you walked a lot. Or said a complete paragraph out loud. Or got a new job. Or slept a whole night. Or chewed and swallowed regular food without incident. Or booked a new OT appointment.

I want to know what's gone well with you, big or small. And I want to share it with the listeners.

You can record a brief message telling me who you are, when your stroke was and what you accomplished. You can do this with the voice memo feature on your phone or another recording process and email that recording to Bill@strokecast.com.

Or you can do it the simple way. Simply call (321) 5stroke, any time day or night, and leave a voicemail describing your win.

I'll share wins in future episodes so we can all celebrate with you.

Hack of the Week

Anna explained we need to take time to check in with ourselves. Yoga breathwork is one way to do that. It doesn't need to be yoga, though. Anna offered 3 key ways to do this.

First, don't shy away from your feelings. A therapist can help you explore them further.

Stroke is trauma. Grieving is natural. Clinical Depression is a common result of stroke (see http://Strokecast.com/depression for more information). It's a major life change and it's perfectly normal to feel feelings about it.

Ignoring them won't make them better. Therapists can help. Neuropsychologists are also available with special training to help folks with brain injuries (see http://Strokecast.com/karen for more details).

Second, acknowledge and recognize anger, anxiety, and other uncomfortable feelings. Those feelings are trying to tell you something. Talk to your anxiety like it's a small child. It wants attention and it's throwing a tantrum. Why?

Third, offer yourself kindness and compassion. You're not an expert in this new body, brain, and life. You'll get things wrong, and that's okay. Forgive yourself for not having it all figured out.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:08 AM 0 comments
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2022-08-15

Dark Moon Shine: Stroke Dialogs from Jeri and her Dad


Jeri Goldstein built an online business coaching musicians who want to book more gigs. After all, success as a musician requires working in the music business. Many aspiring stars are hugely talented with the music side, but not so much the business side. Jeri helps them.

Then the phone call came, and Jeri's life changed. It a good thing her business was highly portable

Her father survived a massive stroke, so Jeri did what she had to do. She packed up the car and the dog and headed down to Florida to help her family navigate the post stroke world and learn to adapt to her father's aphasia.

Jeri chronicled her experience with her dad in her book Stroke Dialogs: Conversations with Dad*. She sent me a copy, and we talked about her experience in this conversation. And she explains what "Dark Moon Shine" is all about.

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

 

Click here for a machine-generated transcript

Who is Jeri Goldstein?

Jeri Goldstein sits out side, smiling with her head resting on her hand.

Jeri Goldstein is a career development coach for professional performing artists and entertainment industry professionals. She coaches musicians performing in all genres of music from traditional acoustic to jazz, classical to world music, children’s music to blues and rock and hip-hop to rap. Jeri has also worked with authors, actors, storytellers, visual artists, and other small business owners. Her specialty is to help her clients discover their unique niche market and to create strategic business and marketing plans.

For twenty years, she was a booking agent and artist manager for touring artists on the acoustic music circuit. She worked with musicians, actors, and dancers.

A picture of the cover of the book Stroke Dialogs: Conversations with Dad

She is a music and book publisher. In addition to Stroke Dialogues*, Jeri has written two other books. Her award-winning book, How To Be Your Own Booking Agent THE Musician’s & Performing Artists Guide To Successful Touring*, is used by musicians world-wide and has been a textbook used in music business courses throughout the U.S. and Canada. It reached #1 on Amazon in the Music Business category and has sold over 60,000 copies world-wide. The Tiny Guide to Huge Success* is a collection of 100 blog posts taken from thirteen years of over 650 entries designed to help performing artists build and maintain a successful touring career.

Jeri presents in-person seminars and keynote lectures at universities, conferences and for businesses and organizations in the music and entertainment industries. Her online course Booking & Touring Success Strategies & Secrets has been taken by hundreds of professional touring artists.

In 2020 she launched her first podcast, Get Great Gigs which featured interviews with artists and other entertainment industry professionals that discussed inspiring career strategies before and during the COVID-19 pandemic.

Jeri began her internet-based business in 2008. Her use of internet marketing strategies and social media provided the perfect platform for her to work from anywhere. In November 2012, she set up shop in Florida to be with her dad during his recovery from a stroke. After selling her home in Charlottesville, VA, she relocated to Delray Beach, FL permanently in August 2015 and continues to live there today.

Homunculus

The homunculus is a representation of the brain and various parts of the body. The more you use a part of the body, the more neurons it takes up in the brain. For example, the hands and tongue take up more space in the than the elbow and pinkie toe.

The more time and energy you dedicate to something, the more space in your brain is dedicated to that task. For example, a homunculus of my brain would likely show a much larger segment dedicated to speaking than to throwing a baseball.

A drawing of the homunculus of the human brain

One way I think about how this applies to survivors (and I may be stretching the homunculus analogy) is that a skill from the prestroke days that a survivor was an expert at may come back before a skill one had limited experience with simply because despite the damage there were simply more nerves dedicated to it.

In the case of Jeri's dad, we have someone who lived a life of numbers. When he lost his words and names with aphasia, he still had numbers.

As you continue to work on a skill post stroke, a larger portion of the brain will be dedicated to it. More nerves, dendrites, and synapses will become involved. This is neuroplasticity at work.

Negotiation

Jeri talked a little about negotiation in this conversation. It's an important skill. It's also important to recognize that negotiation isn't just about resolving an argument. It's a process of working with others to meet everyone's needs as much as possible.

When folks are in a negotiation, it's helpful to articulate and understand priorities and preferences for all participants. And that involves knowing what you care about and why you care about it.

Understanding that "why" is the thing that will keep you open to new and even better solutions.

Self-Publishing and Know your Audience

Jeri self-published her book because she knew her audience. She also knew the process and had done it before when it was a lot harder. The key, though, is she knew the audience.

When selling a book in a hyper-niche space, an independent writer or small, specialized publishing house can have a lot of success.

I like this approach a lot. Often authors self-publish for control because traditional publishers aren't interested. There are plenty of other reasons, too, as previous guests have described.

From a traditional marketing and sales perspective, Jeri started with her audience -- her customers. She knows who will buy her book, and then worked backwards from there, asking, "What is the best way to get this book in their hands?" She concluded that a major publisher would not be as effective with their focus on big retailers.

As an entrepreneur who has sales and marketing skills, she knew she could more effectively reach the niche audience of the stroke world. She opted to self-publish.

Cluster Brainstorming

Cluster brainstorming is a way to identify things that you find important and to drill down on those ideas to get more clarity.

It starts with an idea and then you define that idea in greater detail. And then you go into those definitions and try to understand the.

For example, maybe a goal is to recover from stroke. What does that mean? My successful recovery may look very different from that of a more athletic individual who lived for sports, hiking, and lifting heavy things.

Cluster brainstorming helps you unpack that. You start by writing a word or goal that matters to you. Then you start writing down words associated with that first one. Then you take the most interesting of the words you wrote down and do the same things for those.

At the end of the process, you have a whole bunch of thoughts and ideas on the page, and these are the things that matter to you. These can define the "Why" of your recovery. You can see how smaller or more tactical items. It's easier to do an exercise or activity when it's clear how that exercise or activity fits into the broader picture of your life.

The brainstorming activity can help you identify your priorities, but it's all just a pretty paper until you put it into action and turn these ideas and concepts in the SMART goals that can drive your recovery. You can learn more about SMART goals in episode 86 on this page.

The Tongue Twister

When you're positive and patient,

When you are persistent in practice,

Full recovery is possible

and anything is possible.

That simple tongue twister is one of the tools Jeri worked out for her dad. He needed practice pronouncing his Ps and this did the trick. It also had the extra benefit of providing a positive perspective on his present predicament.

Repeating phrases like this also help you to believe it. It's the repetition that drives neuroplasticity.

It's also a good phrase o use to practice your mic technique for a podcast to keep your plosives under control

Win of the Week

I walked more than 6000 steps in one day during a weekend getaway with my GF. It's quite a bit considering my pace, brace, and cane.

You hear a lot about my wins and my guests' wins on the show. Now, I want to hear about yours.

I'm starting a new feature called the win of the week, and I want to know what went well for you.

Maybe you walked a lot. Or said a complete paragraph out loud. Or got a new job. Or slept a whole night. Or chewed and swallowed regular food without incident. Or booked a new OT appointment.

I want to know what's gone well with you, big or small. And I want to share it with the listeners.

You can record a brief message telling me who you are, when your stroke was and what you accomplished. You can do this with the voice memo feature on your phone or another recording process and email that recording to Bill@strokecast.com.

Or you can do it the simple way. Simply call (321) 5stroke, any time day or night, and leave a voicemail describing your win.

I'll choose from the wins and share my favorites in future episodes so we can all celebrate with you.

Hack of the Week

Jeri cited 3 tips for helping and empowering her dad in his recovery.

First, she placed Labels around the house on objects to help her dad recognize and retain the names. This is similar to the approach that Anna Teal took with her husband is making lists of seasonal phrases to stick on the refrigerator. The reminders and repetition can help rebuild those neural pathways.

Jeri's dad also liked games and puzzles. Playing Bridge with his friends was a highlight of his day before stroke and relearning it after stroke was a priority. It was also an important way to help him interact with friends beyond his immediate family.

Working on puzzles is great practice after stroke. It works on skills around visual processing, pattern recognition, logical and process thinking, and, of course, manual dexterity. Can assembling puzzles solve the missing piece of recovery?

The most important element, though, was letting her dad drive his recovery. Identifying his priorities and his concerns and making them the focus of his recovery efforts kept him involved in his recovery. The more interested we are in the activities of therapy and the goals of therapy, the more likely we are to do the activities of therapy.

Plus, making sure the survivor has agency in this process matters. Because therapy is not something done to a survivor. It's something done by a survivor.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:09 AM 0 comments
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2022-07-27

Stroke from a Genetic Condition Ended this Entrepreneur's Dream & Drove a New One


Depression sucks, and it lies. It's a life threatening condition that affects a lot of stroke survivors and can block their recoveries.

In 2010, business owner Keith Taylor survived a stroke. A rare genetic condition meant that the arteries and veins in his body don't always connect the way they're supposed. It's called Hereditary hemorrhagic telangiectasia (HHT). One day, that flawed connection leaked and began killing brain cell.

Keith began his journey through the stroke care system of the time, into the depths of depression, leaving the business he planned his life around  and to the life he lives today helping stroke survivors in Central Oregon and around the world live their best lives. He shares his journey in today's episode.

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

 

Click here for a machine-generated transcript

Who is Keith Taylor?

Keith Taylor wears a blazer and looks at the camera against a dark backgroundKeith Taylor runs Strength After Stroke

Keith Taylor is a deeply passionate, and dedicated leader in the stroke community. He is dedicated to helping stroke survivors regain their own power and strength to live a full and productive life. While owning and being the sales manager of a large manufacturing business in Oregon, he had a stroke at the age of 48. After looking for, and not finding, anyone to help with the depression and lack of confidence after his stroke, he decided to create that for other stroke survivors.

He is President of the Board of Directors with Stroke Awareness Oregon and is the owner of Strength after Stroke; a company dedicated to providing resources for stroke survivors to re-ignite their desires and regain their confidence.

What is HHT?

HHT stands for Hereditary hemorrhagic telangiectasia. That tells most of us…absolutely nothing.

The condition impacts the way the blood vessels in our body connect.

When the circulatory system works properly, blood flows from the heart under high pressure through the arteries to deliver oxygen and nutrients to the organs throughout the body. One big artery (the aorta) comes off the heart and splits into smaller and smaller arteries that carry blood to the kidneys, the toes, the brain, and every other part. The arteries are built to withstand the blood pressure.

Veins take blood from the organs and bring it back to the heart. Along the way, the deliver carbon dioxide to the lungs and waste material to the kidneys, liver, and other disposal sites. The blood is no longer under such high pressure at this point.

In between, there are capillaries. These are the tiny, thin blood vessels that allow oxygen and nutrients to pass from the blood to the organs and for carbon dioxide to pass back. Arteries branch smaller and smaller and thinner and thinner to become this huge network of capillaries, which the consolidate and get bigger and bigger until they become veins. Meanwhile, that branching down and consolidating up reduces the pressure on the blood in the system

In a patient with HHT, those capillaries don't always form where they are supposed to. Instead, the arteries will connect directly to the veins. These malformations are weak spots since the veins may not be able to handle the pressure of the blood coming into them. These AVMs, or arterial-venous malformations can then rupture or leak resulting in a hemorrhagic stroke.

You can learn more about HHT at the CDC's website here: https://www.cdc.gov/ncbddd/hht/index.html#:~:text=HHT%20is%20a%20disorder%20in,present%20between%20arteries%20and%20veins.

HHT is not the only cause of AVMs but it is an important one.

Nosebleeds

Nosebleeds are an important signal that something may be wrong. Frequent or regular nosebleeds are something to discuss with your doctor.

Nosebleeds are a common indicator of HHT. Someone who has HHT will need to keep on top of their monitoring to reduce the chances of a dangerous stroke or other conditions. HHT by itself doesn't have many visible symptoms so nosebleeds can be a good flag.

In my case, it was nosebleeds that revealed my high blood pressure, which remains one of the top causes of stroke. The problem, of course, with high blood pressure is that it doesn't hurt. Unless you're checking it, you won't know you have it. Nosebleeds, however, are one powerful indicator.

If you or someone you care about has frequent nosebleeds, discuss it with your doctor. There can be lots of different causes, but often the nosebleed is the least severe consequence of that cause.

Depression Lies

I talk about depression a lot on the show because it is a big deal and stroke has been shown to cause depression. Depression can be a deadly disease.

It can also tell us not to get out of bed. Or to skip our exercises. Or to question if we should even be here. Or try to convince us we are a burden to the people who love us.

Depression interferes with our recovery, our energy, our relationships, and our view of the future.

But always remember the biggest fact about depression: Depression lies. All the time.

I first encountered this concept while reading a blog post from writer, actor, and professional geek Wil Wheaton. You can see that post at http://Strokecast.com/DepressionLies

When depression says we shouldn’t get out of bed or off the couch, depression lies.

When depression tells us our friends and families wish we weren't there, depression lies.

When depression tells us to skip therapy because it doesn't matter, depression lies.

Don't listen to the liar that is depression. Help is available. Your doctor therapist will be happy to point you in the right direction.

Hack of the Week

When you forget a name or word, channel your inner Elsa, and let it go. Just relax. It's okay to struggle with names and words. People you deal with will be okay with it. The more you stress about it, the harder it will be to remember and the more likely you are to struggle with other words, too.

Often we worry about what strangers will think about us when we are out and about, but the thing is they don't really care. Everyone we see is caught up in their own fear that everyone is judging them that they don't have the attention or energy to actually judge others.

If you think someone does give you a dirty look or something like that, remind yourself that their probably thinking about that cringey thing they said at their 8th grade dance. Somehow it just smacks them at random from the depths of their memory.

But the key is that's it's not about you. So relax.

And let it go.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:15 AM 0 comments
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2022-07-12

Life Coach Survived 2 Strokes and a TBI


Julie Kuch had her first stroke in 2009 when she was 30. No one believed her at the time, and she had to convince a neurologist to order an MRI before the medical system began to take her seriously.

And once they did take her seriously, the system still didn't offer Julie rehab or even education about how to live life as a stroke survivor.

Several years later, Julie had a do-over -- her second stroke. Oh, and she through in a TBI in between.

Between her strokes, Julie created the services she wished she had for her own stroke. She became a life coach for brain injury survivors.

To learn just what a life coach does, how their services help, and how Julie built this life, listen to this episode.

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

 

Click here for a machine-generated transcript

Who is Julie Kuch?

Julie Kuch headshot where she looks at the camera wearing a denim jacket in the kitchen

Julie is a concussion and stroke survivor. She is a Life Coach for people who have had a brain injury. She has helped 100’s of people find joy and purpose in life again.

Julie has survived to strokes and a TBI. Her second stroke was in January 2022. She is currently recovering (very well) from this, her third brain injury. The experience has Julie feeling more passionate than ever that part of her mission in this life is to help as many people as possible recover and feel better than before their brain injury.

Julie is grateful for her brain injuries and the valuable lessons they have given her.

Julie wants everyone that has experienced a TBI to feel the same, and she know they can. Julie says, "So much of the suffering we go through recovering from brain injuries is not necessary. I teach my clients how to transform from feeling resentful, frustrated, angry, shameful and depressed about the state of their life to feeling accepting, loving, and at peace about themselves and their capacity after a brain injury."

Julie certified as a Life Coach through The Life Coach School.

A Go Getter Gets Depression

Depression is a topic we don't talk about often enough. It's a common stroke deficit, like hemiparesis and aphasia. It interferes with recovery and exercise routines.

And it’s not just feeling sad or mourning the end of your previous life. It's a genuine problem that burns energy and can make it even harder to get out of bed and do PT. Or do the basics of taking care of ourselves.

Last year, I talked with Dr. Laura Stein from Mount Sanai in New York. She talked about new research showing that stroke itself causes major depression, and not just the impacts of stroke.

In 2009, no one told Julie she might encounter depression. We also had less overall public awareness about depression. And when it did hit Julie, she was not prepared to deal with it. She had to deal with her own limiting beliefs about antidepressant medication and about people with depression.

Julie talks about the shame and embarrassment she had around her treatment. By 2022, she was better prepared to deal with it.

Depression, like stroke, can happen to anyone. It can be a deadly condition. And like any other stroke deficit, it's nothing to be ashamed of.

We can know that, but that doesn't guarantee we'll believe that.

Why drive during a stroke?

Julie had her stroke while she was driving to the doctor's office. But she didn't pull over and call an ambulance.

Jo Ann Glim had her stroke in a deli while trying to fix an office sandwich crisis.

Misha Montana drove back to Reno while having a stroke.

James Horton drove home while having a stroke,

Driving while experiencing a stroke is a terrible idea. It's dangerous. It's difficult.

The problem is that we rely on our brains to evaluate every situation of every minute of every day. In a stroke, though, the brain is under attack. Millions of brain cells are dying every minute. Various parts are scrambling in panic mode to figure out what is happening, what no longer works, and what to do next.

The part that should tell us what common sense is has become the part that is broken.

So, what can we do?

We talk about neuroplasticity as how we recover after stroke. The core principle is, "Cells that fire together, wire together." 

It's not just recovery, though. Neuroplasticity governs how we learn. We say things like "Practice makes perfect" because doing something repeatedly is often how we learn it. Practice IS the firing together of neuroplasticity. The more we repeat a thing, the more resilient the connections in our brains become. The bigger they become. The more permanent they become.

If you grew up in the US and I say, "I pledge allegiance…" you probably immediately want to say, "to the flag."

If you grew up Catholic and I say, "In the name of the father," you probably felt the urge to touch your forehead.

These are patterns we developed over years of repetition.

Here's how this impacts driving. By repeating BE FAST early and often, we internalize not only the most common symptoms of stroke, but also the action. T = Time to call an ambulance.

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.

Repeat it until "Time to call an ambulance" is as ingrained as the sign of the cross or the pledge of allegiance. In a crisis, that may then be the course of action the dying brain grabs on to.

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),

Helmets Save Lives

Julie told the story of her concussion during the conversation. This is a picture of the helmet she was wearing at the time.

Yes, she still suffered a traumatic brain injury in the accident, but the helmet took the brunt of it. When you look at the dent in that image, it might not look too dramatic, but if you take another look and then imagine what that would look like on someone's head.

A picture of Julie Kuch's snowboard hellmet with a significant dent and major scratch from a collision with another snowboarder. The crash gave Julie a significant concussion, but the helmet saved her life.

Now that's terrifying.

What is a Life coach?

Julie is a Life Coach for brain injury survivors. But what does that mean?

As Julie describes it, she helps live their best life. In some respects, it's similar to what a mental health professional does, but to a lesser degree.

A life coach helps a client develop practical skills for life within the context of the coach's expertise.

A big part of Julies work is helping folks understand the difference between facts and thoughts. Often, we assume that our thoughts are facts, and that causes problems. Saying it's 73 degrees is a fact. Saying it's too warm to do PT is an opinion or a thought. When we act on thoughts like that, we can limit our recovery.

Many of us have limiting beliefs about our abilities, relationships, money, and more. Those limiting beliefs are things that we have convinced ourselves are facts when in reality they are not. And yet they have become part of the way our brain interprets the world due to neuro plasticity.

A life coach like Julie helps clients unpack those limiting beliefs and jettison the ones that don't work. Freeing yourself from your limiting beliefs allows you to achieve more.

While a life coach is not a replacement for a psychologist, they can still help people live better lives.

Hack of the Week

There are three tools that helped Julie with the mindset of recovery that she uses with her clients,

First, mourn the life that could have been.

After a brain injury, life will be different. We are different. Some disabilities may be short term while others are long term. It's okay to be sad and disappointed. Getting stuck in sadness and disappointment won't undo the injury, though. It will only delay your entry in a new and possibly amazing life.

Taking time to mourn the life that could have been can help you move on to the life yet to be.

Second, receive the gift of rest.

Rest and sleep are important, yet many of us flee from them (myself included too many times). That's where much of the work of healing happens though. A brain focused on just getting to the next big thing isn't taking the time it needs to prepare for the next big thing. Take the time to rest and recover.

Third, manage your thoughts.

The key principle behind Julie's coaching is that thoughts and opinions direct our actions and beliefs. We think they are immutable, but they are not. We can change them. We can decide which ones to dwell on.

The core idea of neuroplasticity is that "nerves that fire together, wire together." PT, OT, and Speech Therapy are governed by this theory. It's why we have to do thousands of repetitions to rediscover our limbs and build new pathways in our brains.

And it's why dwelling and revisiting unhelpful thoughts is not helpful. The more often we think something or repeat a belief, the more the nerves will wire that thought or belief, giving the brain a shortcut to that thought or belief.

Make sure you leverage the power of neuroplasticity to bring good things into your life.

Better year for Geek Movies: 1982 or 1989?

I was just on the Caffeinated Comics Podcast where we discussed this question along with the trends that transformed movies through the 80s. From Bladerunner to Batman, and Tron to the Little Mermaid, a lot of amazing movies came out in those years.

You can hear us discuss it on the podcast here: https://radiomisfits.com/cc286/

Or you can listen and watch on YouTube right here:

https://youtu.be/b4gY3KD17i4

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:08 AM 0 comments
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2022-06-30

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

 

Click here for a machine-generated transcript

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.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

Posted by Cromely at 7:09 AM 0 comments
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