WHAT IS A STROKE?

First off all a stroke is a heart attack in the brain.

 

From http://www.medicalnewstoday.com/articles/7624.php we learn that:

A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen.  A stroke can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain.

The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.  Stroke is the fourth leading cause of death in America and a leading cause of adult disability.

There are 2 main kinds of strokes, ischemic stroke and hemorrhagic stroke:

Ischemic stroke

Ischemic stroke accounts for about 87 percent of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain.

If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

Hemorrhagic stroke

A hemorrhagic stroke occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

A 3rd type of stroke is called a TIA:

A transient ischemic attack (TIA) may be a sign of an impending, much more serious, stroke. A TIA is a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter period and do not leave noticeable permanent damage.

If you follow sports you may have heard that professional ice hockey player Kris Letang of the Pittsburgh Penguin’s had a stroke while on the ice. A few weeks later he was playing again. He experienced a TIA. He was ‘lucky’.  Those who experience a more serious stroke are, almost certainly, are in for some form of long term disability. (which is a nice word for ‘inability’)  Recovering from a serious stroke means having to reprogram a brain and teach it to do something it lost the ability to do.

After my stroke I could barely speak, barely read a sentence without getting tired, completely unable to write, and at first was confined to a wheel chair, then a walker, a quad cane, cane and several months later able to hobble about without needing any of the above.

THE FEAR OF FALLING

Falling is fearful because a head injury could cause another stroke, a cracked skull, a concussion, even sudden death.

Over a period of 1.5 years 4 serious falls happened in which I could not get up without someone’s help.  The first fall occurred shortly after my return home, after 23 days in the hospital.  My wife, Julie, got out a lawn chair for me so that I could enjoy being out doors.  The chair was on our ever so slightly angled drive way. I tried to stand and the next thing I knew was that I had fallen over onto the pavement, and luckily my headed laded not on the cement but rather in the soil. I could not get up.  Julie rushed into the garage to get me a padded kneeler. She could not lift me.  We started laughing at how ridiculous and real this was. (crying was the other option).  She got me turned back toward the chair and I was able to pull myself up.

Talk about feeling humiliated. After all I once played on ice hockey teams for 5 years, baseball teams for 6 years, could jog 6 miles, 3 x / wk. (mid 60’s) and trekked in the Himalayas for 18 days…twice above timber line. I could even stand on my head, fold my legs into a full lotus position and low myself still sitting fully in it. Gym workouts were a regular routine. My wife and I walked 6 days a week, So there I was unable to pick myself off the ground.

The second fall occurred when trying to step up over a low 2 inch curb that led into a fast food restaurant. Thankfully one of the employees (a teenager) rushed out the door to get me back on my feet. Seems his uncle had had a stroke and he knew how to help.

My third fall was New Years eve, 2013. We intended to have breakfast out and as I attempted to step up over a high curb onto the walk way; my affected right foot tripped over the curb and my body propelled forward. I did not have enough balance to catch myself in order to prevent the fall. Out of the left corner of my eye I saw two things, landscaping surrounded by soil and a cement retaining wall. I aimed for the landscaping but missed.  The right side of my right eye and forehead slammed into the concrete causing my body to flip over on my back. I was shaking and moaning. My wife screaming. A man ran out of the restaurant to help me up.  The impact left a welt on my forehead as big as a Hostess Twinkie. The next day I had a full blown, boxers, black eye, that took 45 days to dissipate.  The welt on my forehead took well over a year to settle down and feel normal to the touch.

The fourth fall was at a Stroke Survivors Christmas Party. About 10 feet from the entrance way was a step down family room. Many people arrived at the same time causing me to back up, fall backwards off the step and crash to the floor. Thankfully I landed on my unaffected left side. Although everyone screamed I was unhurt. Praise God.  I have not fallen since… but still wobble a lot, but can now catch myself.

Annually, 700 000 people in the United States suffer a stroke, or 1 person every 45 seconds, and nearly one third of these strokes are recurrent. More than half of men and women under the age of 65 years who have a stroke die within 8 years. In the USA alone there are an estimated 5,000,000 stroke survivors.  About 10% die from a stroke.

MEDICARE & OTHER INSURANCE

Thanks to Medicare I was given 8 months of out patient therapy.  The importance of which cannot be underestimated.  I underlined Medicare because those who have a stroke prior to age 65  will NOT get all the therapy they need to adequately recover. (perhaps a school teacher or government employee will receive adequate therapy because of their excellent insurance coverage) but here in the real world of insurance, companies easily limit the amount of money they will spend on your behalf. As a result most stroke patients I know were limited to a mere 6-8 weeks of therapy. That’s why most stroke survivors can not use a hand, arm or limb very well, if at all.

A CLOGGED ARTERY

The clogged artery in my brain stem totally cut off the oxygen supply to portions of my brain; literally killing them off. The parts of my brain that control finger, hand, wrist, arm, shoulder, toes, ankles, calf, knee, quad, hamstring, swallowing and speech coordination were destroyed. It was now going to be my task to reprogram my brain how to operate the right side of this body. Imagine having to do that?  Putting that in perspective let’s say you are raising or have raised a child who liked sports. How much practice would he have to endure in order to throw a 100 mph fast ball? Or become a professional ballerina?  It would take 20 plus years of practice, if ever. Therefore it is unlikely that I will ever be able to duplicate, in the years I have left, what 67 years of movement had programmed into my brain!

My understanding is this: God created us as perpetual motion machines with human potential; giving us the ability to move our bodies in any direction we are willing to work at and train. It was a free gift with intention.  But an injury to the brain, like a stroke, destroys path ways and neurons and it is up to the individual to try to remap the seeming endless amounts of movements required to re-grow those neuronal connections. It is a daunting task, if at all possible.

WHAT REMAPPING FEELS LIKE

Let me try and describe what it feels like to try to move a body part that will not move.

1. In the hospital bed I could not roll over or change position…. it was as if my body was frozen; like moving dead weight. It took two nurses to roll me over every few hours.

2.  My fingers were locked into a claw. They would not separate. It took a week of effort to separate my thumb from my pointer finger. The space between them was a mere 1/4 inch but it was a significant improvement. It took about a month to be able to touch my thumb to my pinky finger. To this day the tip of my pointer finger is not straight and my pinky will barely lift off the table.

3. One of the first occupational therapy sessions had me on my back, arms at my side. The therapist had to lift my arm off the table because I could not. The goal of the exercise was to lift my arm straight up and rotate it backwards at the shoulder. It was like trying to move a two hundred year old door with a rusty hinge… it hurt.

4. When the physical therapist wheeled me into the therapy room and said, “We are going to stand you up, with the help of a walker, and you are going to move forward.” I was afraid, afraid of falling. My right leg could not hold me up.

5. My cognition is limited. I have a hard time thinking things through without a mistake.  My voice pattern has changed. I am no longer glib. For the first two years I mumbled and many letter combinations were difficult to pronounce. Talking on the phone was embarrassing…. but I had to do it and did.

6. I could not eat with a utensil in my right hand, and could not lift it to my mouth. This took several months to accomplish.

7. Driving. It took over a year before I could drive a mile; nearly 2 years before I could drive alone.

To this day my right arm will not go straight at the elbow nor shoulder, which makes reaching difficult. My right leg, at the knee and ankle will not easily ‘flip’, which is need to walk fluidly. (Watch someone walk and note how quickly the foot and knee ‘flip’)  The brain is in no hurry to remap and the process of re-growing synapses is extremely frustrating and time consuming.  Few stroke survivors experience complete recovery from a ‘serious’ stroke.

The part of my brain that was stroked is the PONS, in the brain stem. The PONS, as its French words implies is the ‘bridge’ between messages sent from the spinal column through the PONS to the brain. It controls coordination, balance, sleep, breathing, the tongue and much more.  It is designed as the superhighway for sending signals across the bridge. After a PONS stroke the superhighway is destroyed causing all signals to travel on bumpy side roads. I am forced to take slow brain pathways that were once rapid, quick, accurate, movements are impossible.

The stroke has been really hard on Julie, my dear wife, because the stroke did not happen to her, yet she has had to lay down her life and be my care giver; which is very difficult. Her loving care giving has meant doing all house related chores, in and out, pay all bills and do all the shopping while I exercise trying to regain a more normal life.  Without her attending most therapy sessions, taking notes, and making sure I do at home was the therapist suggested, I would still be using a walker. She has walked along side of me, holding my arm when needed and totally setting her life a side to help me regain mine. (Reminds me of the oath most people swear on their Wedding Day: “for better or worse, till death do us part”) She is a living example of those words.

Although I have made great progress: I can move about without a cane (but slowly with a noticeable limp), make breakfast every day, drive the car alone. None-the-less I am now wondering if full recovery is at all possible? I doubt that my affected right side will ever mimic my unscathed left side.

The stroke was also very hard on our business. In the first year after the stroke I was helpless to accomplish anything.  Praise God our son in law, Ryan, had been helping me in the business for a couple of years, part time, and after the stroke was able to jump in the hot seat and managed to keep it going.

FITNESS after a STROKE

Prior to my stroke I was very fit. I lifted weights 2-3 times per week. For an older guy I was in great shape. 40lb curls, 225 bench, etc.

3 days after the stroke, while sitting up in a hospital bed, I reach over with my left hand and grabbed the bicep of my right arm. It was not there! What? The muscle had gone completely flaccid. As if the muscle mass had deflated. I sat there trying to focus all the energy of my mind in order to contract the muscle. But alas, it was gone. It would be several months before some muscle strength returned.  7 months later, after leaving 2-3 times per week therapy sessions behind, I took on a personal trainer at a local gym.

I learned the following:

1. Only proper posture and proper lifting techniques had any hope of returning me to normal as even my skeletal structure was out of alignment. Lots of reps were necessary as I had to rebuild strength. For instance, Pre stroke I was able to leg presses 1200 lbs. Post stroke I could not leg presses 140 lbs

2. Focusing most effort on strengthening the affected side until such time as it catches up with the strength of the unaffected side; which has not happened yet for any exercise.

3. Lots of cardio, as the thread mill allows one to hold on while trying to reestablish a proper walking gait.

4. Walking out doors, as often as possible.

5. Terrain walking; with a cane or walking stick, is possible.  Walking downhill is frightening.

6. Stair climbing greatly helps remap proper hip motion and coordinates the quad and foot.

Prior to my stroke I loved doing pushups. I could do 35-40. It has now been over 3 years and I cannot do even one! Utter frustration.

The effort it takes to even attempt to re-teach a brain how to walk is beyond hard work… it is exasperating, frustrating, disenchanting. It seems to take thousands of repetitions of the same movement to gain a millimeter of neuronal growth. And then one can not be certain that the newly created pathways are actually achieving the movement desired.

THERAPY

A note about Therapists; physical, occupational and speech:

Therapists understand what one needs to do and practice in order to remap the brain in proper order.  No matter how much of a fitness background I had… and believe me, after a stroke you do not know which movements to try next. It is as if your perception is gone.

These past three years have been not only very frustrating but also depressing. It often causes me to feel hopeless, helpless and useless. There are so many things I just cannot do. I am especially saddened after attending the local Stroke and Brain Damaged Survivors Group meetings at a local hospital, as most survivors have no chance of any more recovery. (thanks to the horrific, mean, almost punishing, attitude of most insurance companies.)

Although fewer than 14% of stroke survivors achieve a full recovery in physical function, between 25% and 50% require at least some assistance with activities of daily life. 

Although being over weight, smoking and high blood pressure are strong indicators for stroke the issue for me was atherosclerosis… which is difficult to reverse but I am working on it. My mom worked in a bakery. As a kid we ate a lot of baked goods loaded with artery clogging trans-fats and sugar. Help. Poor innocent me.

WHAT ARE THE SYMPTOMS OF A STROKE?

Within a few minutes of having a stroke brain cells begin to die and symptoms emerge. It is important to recognize the symptoms, as prompt treatment is crucial to recovery. Call 911 and get to a hospital quickly.

Common symptoms include:

• Trouble walking, loss of balance and coordination.
• Speech problems.
• Dizziness.
• Numbness, weakness, or paralysis.
• Blurred, blackened, or double vision.
• Severe headache.
• Sudden confusion.

Source: http://www.medicalnewstoday.com/articles/7624.php

IN CONCLUSION

Strokes drastically affect life, life style and goals.  Having a stroke forces one to reassess everything: even having to plan for the worst, another stroke or sudden death.  Going into a store implies tight space, crowds, little kids running around and the possibility of being knocked off balance.

Traveling or simple outings bring up logistical issues like the need for rest, sitting or standing too long (which stiffens up the leg). In restaurants will seats have cushions?  How much will I be able to do when we get were we are going? Is it in fact worth going?

My life has changed forever. Learning to live with limitations is real hard to accept.  10’s of million of handicapped people face this daily: everyday tasks are very difficult if not impossible.  On the positive side of having a stroke my compassion for others has greatly increased as I can now personally relate to their frustrations.

One thing all stroke survivors report is that many one time ‘friends’ are no longer stay in contact.  Do me, others and yourself a favor: Lots of people are struggling with physical limitations…. help them when you can. If you know someone ‘stuck’ in the house, call or visit.  Until then, life remains a journey for all, one step at a time, whether you can move fast or have to move slowly.

REFERENCES

• Medical News Today-http://www.medicalnewstoday.com/articles/7624.php