Lots of stroke survivors joined the stroke club due to high blood pressure. I'm one of them. The biggest challenge with high blood pressure is that it doesn't hurt. Most people will feel no symptoms unless something goes terribly wrong. Or they might learn they have the condition if they get an annual physical. Because of the danger of high blood pressure directly, and because of the danger of other conditions that manifest as high blood pressure, it's important to check it regularly, and that doesn't mean you have to go to the doctor every week. You can find home blood pressure meters all over the place -- from Amazon to Costco to the corner grocery store. But which one is best? And what do you need to know if you've already had a stroke? This week, I'm joined by Carol Lucarelli of Omron Healthcare. Omron is a leading manufacturer of home blood pressure meters. In fact, one of their devices is sitting on the table next to me as I type this. It was that very device that gave me the 210 over 160 reading that kicked off my stroke story several years ago. More recently it read 134 over 77 -- not perfect, but still much better than the condition that collapsed my right middle cerebral artery. One reason I wanted to talk with Carol was that I heard about Omron's Going for Zero mission. The other reason is that I like tech and gadgets, especially when they can save lives. IMAGINE A HEALTHIER WORLD We believe the next generation won’t be defined by age, but by a world without heart attacks or strokes. This is a world-changing mind-set we call Going for Zero™. We do our part through technology supporting personal fitness, heart health, healthy lungs and freedom from pain. You bring this commitment to life by understanding and sharing heart health with every step. https://omronhealthcare.com/generation-zero/ Carol joins us to talk about how these devices work, how they compare to the doctor's office, and why we should trust devices from Omron from wrist devices to upper arm cuffs to smart watches. If you don't see the audio player below, click here to listen to the conversation on the original site.   Click here for an AI-generated transcript Who is Carol Lucarelli? Carol Lucarelli is the Executive Director of Marketing and Ecommerce at OMRON Healthcare, the global leader in personal heart health and wellness technology. Lucarelli is a seasoned marketing professional with over 25 years of experience in the consumer packaged goods space. During her time at OMRON, Lucarelli has led the marketing initiatives for numerous product innovations, including the launches of HeartGuide Complete as well as VitalSight, OMRON’s first remote patient monitoring service. Wrist vs Arm Home blood pressure monitors typically come in two types -- wrist or upper arm. The wrist mounted devices are typically smaller. You simply put it on your wrist, secure it, press a button, and raise your hand to get it at the appropriate level. The upper arm models will typically wrap around your bicep or upper arm. Some will have the guts of the device on the cuff; others will have a hose that goes to a device on your desk, table, or lap. In the past, I assumed the upper arm would be the more reliable device because that's what many medical facilities use. Over the past few years, though, I've seen more medical teams using the wrist versions for convenience. Carol also explained that whether it's wrist mounted or upper arm mounted, the devices are held to the exact same standard of accuracy. As long as a device is on the Validated Device List, you can assume the model is accurate. Ask your doctor if they have a recommendation. There are all sorts of health reasons why one style might work better for someone than another style. Different deficits after stroke may impact the choice. While cognitive, language, sensory, and pain challenges can all have an impact, hemiparesis - or limb paralysis - is probably the bigger factor. Once you choose your device, it's also a good idea to bring it with you the next time you go to the doctor. This way your doctor can double-check its accuracy against their own blood pressure equipment. While the Validated Device list ensures your model is generally accurate, this process ensures your particular meter is accurate. Hemiparesis recommendations Typically, we take blood pressure measurements on the left arm. It's closer to the heart and will provide a more accurate reading for non-stroke folks. After stroke, a stroke affected limb, however, doesn't have the same muscle activity of a non-affected limb. And that muscle activity affects blood pressure readings. That limb may also experience more edema or swelling due to less effective circulation, lymphatic draining, and other things. That can also impact the blood pressure readings. So, to correctly read blood pressure, you should take a reading on the unaffected side. A difference of 10 points between the sides is not uncommon. The other issue that impacts readings is arm position. The cuff where the reading takes place should be level with the heart. With an upper arm cuff, that's easy. With a wrist mounted device, it's more challenging. You have to be able to lift the wrist to the same height as the heart. Your arm is also supposed to be relaxed when you take the reading so it should be on a bed, table, shelf, or some other item to hold it at heart level. To get an accurate reading, the arm should not be held up under its own power. If you have a care partner who can fasten the device, great. Then an upper arm device can be easy to use. You don't need to worry about arm height because it's naturally at heart level. If the main unit connects via hose to the cuff, you can even use the unaffected hand to push the ON button. If you're by yourself, the problem is fastening the cuff in the first place. It took me several years after stroke until my left arm had enough strength and dexterity to tighten the cuff on my upper arm. Sometimes I still don't get it right and have to try again. Fighting with that costs energy and aggravation, which raises my blood pressure so now I have to take extra time to make sure I relax adequately to get an accurate reading. Once the cuff is set and I chill out a bit, I can get a good reading. A wrist cuff is easier to put on. It still requires a certain amount of dexterity and strength in my affected hand, but it's much less. And it's easier to reach the strap with my teeth, so I can use my bite to help tighten the straps. Then the trick is to get it at heart level. Sitting up can be tough because I have to use my affected side to lift my unaffected arm so I'm not messing with the reading by using the strength in the arm with the monitor. One solution to that which works with both types is to take readings in my recliner our lounge chair. I can get strapped in and then lay back with my arms in neutral positions and the device naturally at heart level, relative to the ground. So, putting the device on is likely easier with a wrist device. Getting an accurate reading is likely easier with an upper arm device. Of course, that all assumes I'm doing this by myself. If someone is able to consistently help, it changes that calculation a bit. Consider your goals, your deficits, and your doctors' recommendations. Try some different devices to find the one that you will use most consistently to generate the most accurate readings. Though the Omron Heart Guide wrist monitor / smart watch does activate my technolust… Getting Good Data Carol gave four recommendations for getting an accurate reading. First, sit upright in a hard-back chair. No slouching. This will give you a good base to start from, assuming your deficits allow you to do this. Second, be seated for 5-10 minutes before taking your reading. If you've been moving around from place to place or doing your sit-to-stand exercises for the day, your blood pressure will likely be elevated from that activity. Third, keep the cuff at heart level.  If it's an upper arm cuff, that's easy. If it's a wrist cuff, you may need to support the arm that's wearing the device. Fourth, keep your feet flat on the ground, assuming tone and spasticity allow that. Crossing your legs or ankles will restrict the flow of blood and reduce the accuracy of your readings. These tips will help you get readings, but more important than your exact posture is taking your readings in the same (or similar) posture each time to ensure consistency. Often the trends over time are more important than any particular reading. Validated Device List Whichever style of meter you choose, you want it to be accurate. And a good place to start is the Validated Device List. The Validated Device list is maintained by the American Medical Association. The devices on it have been evaluated by a third party to ensure they meet the standards for accuracy that doctors can trust. While Omron has a bunch of devices on this list, it includes plenty of other manufacturers, too. All of these devices will meet the minimum standards for accuracy. Consistency We end up talking about consistency a lot on this show. Carol talks about the importance of taking blood pressure readings consistently. The actual result often matters less than the trends over time. And the only way to spot trends over time is to consistently collect that data, like brushing your teeth. Consistency isn't just about blood pressure. Consistently executing a PT, OT, or SLP home exercise program is one of the keys to recovery. We talk about the thousands of reps needed for neuroplasticity over time, but it's the consistency that will make that happen. Doing 100 reps a day, every day will yield better results than doing 1,000 reps once a week. The core call to action for every episode of the show is, "Don't get best…get better." You don't have to become the best at anything to be successful; it's likely to be a fool's errand. Instead, just try to get a little better every day. Consistent work to improve just a tiny bit can add up to huge gains over time. What consistency lacks in flash and drama, it makes up for in long-term results. Hack of the Week Carol shared a couple tips and I have one of my own this week. First, use electronic reminders around the house. That could include smart phone alarms. Or it could be devices like the Amazon Alexa or the Google Home devices. Set those devices to remind you to check your blood pressure, take your medication, do your exercises, or whatever. Your brain is doing enough in recovery. If you can outsource some routine stuff to robots, go for it. When there are things about your devices that you don't like, let the manufacturer know. When enough people make suggestions or point out problems, then they may realize changes need to be made. If they don't hear from customers, or customers whose business they lost, it's a lot harder to make the most appropriate changes to the products. And, while I could be wrong (and hope I am) I don't think most medical device companies have folks with hemiparesis working in their engineering departments. Finally, my biggest struggle with an upper arm blood pressure cuff is tightening it adequately with my affected hand. My strength and dexterity are improving, but I still have a long way to go. One trick I have is to tighten it around my elbow and lower arm. I still can't tighten it all the way; it will be loose there. Once I have that secure though, I can slide it up to my upper arm (with effort). While it was loose on my lower arm, because my upper arm is bigger, it is now tight enough to get a reading without the machine throwing an error message. Links Where do we go from here? If you don't already have one, get a home blood pressure monitor from the Validated Device list and check your blood pressure consistently. The magic numbers you are looking for are 120/80. Share this episode and article with someone you know by giving the, the link http://Strokecast.com/Omron Subscribe to the Strokecast newsletter at http://Strokecast.com/News Don't get best…get better. More thoughts from Carol Lucarelli    

Pain sucks. Chronic pain sucks even more. And for many stroke survivors, this is now their life. Actress, artist, documentarian, and stroke survivor Maggie Whittum explored the world of chronic pain with us in episode 38 and with Barbie dolls filled with nails or covered in suffocating clay. Other survivors have talked about living with pain, even when there is nothing "wrong" with the limb.  View this post on Instagram A post shared by Maggie Whittum (@maggiewhittum) //www.instagram.com/embed.js And once you've lived with pain for several months you don't become accustomed to it. In fact, the nervous system increases  your response to pain. So what's going on here? The brain damage from stroke drives chronic pain in many survivors through a perfect storm of symptoms: Decrease in sensory filtering Increase in sensitivity Homuncular changes in the mind-body connection In this conversation, Physiotherapist and pain specialist Brendon Haslam joins us to talk about the nature of post stroke pain, how clinicians may treat it, why some medication work while others don't, and how, after stroke, we may no longer know just how big or small our hand is. If you don't see the audio player below, visit the original article page here. Click here for an AI-generated transcript Who is Brendon Haslam? Brendon is a physiotherapist and current PhD candidate with the University of Melbourne. Brendon has a particular interest in pain following stroke, and his PhD is focusing on identifying contributions to upper limb pain in stroke, and understanding possible neural networks involved in the pain experience.  The aim of this research is to increase understanding of pain following stroke, and subsequently develop effective interventions to manage the significant problem of chronic pain in stroke. What is chronic pain? Once someone experiences a pain for 3 months, it's considered chronic pain. The nature of chronic pain after stroke goes deeper, though. For one thing, we normally think of pain as resulting from tissue damage or injury. While sometimes joint injury, shoulder subluxation, tendonitis, and other conditions may be a factor, they don't tell the whole story. For example, lightly touching an affected limb may be extremely painful. Applying the exact same stimulus to and unaffected limb and an affected limb may feel like nothing on one side and extremely painful on the other, even if there is no physical difference in the stimuli. A stroke affected limb may just hurt for no obvious reason. And that can be what the survivor just has to live with. Over the last 20-25 years, as Brendon explains, our understanding of pain has evolved quite a bit. We no longer think of it as coming from specific pain receptors. Rather, it a broader sense of safety or danger to the body. And the more someone lives with chronic pain, the more sensitive the nerves at the spine will become to those sensations. Rather than learning to ignore the pain, we can become even more sensitive to it. One of the biggest challenges with stroke recovery is how the brain sometimes loses the ability to inhibit or disregard signals and data. In the case of chronic pain, the brain fails to disregard those signals as the spinal cord in effect raises the volume. In the case of tone and spasticity, as we learned from Dr. Wayne Feng, the brain loses the ability to inhibit signals from the spine to the affected limbs that drive tone. For some survivors, like artist Seth Ian Shearer and NeuroNerd Joe Borges, the stroke reduced the ability of their brains to filter out or inhibit external sensory input. The go out and about with sunglasses and earphones to navigate the world. Stroke is as much about the brain no longer stopping things as it is about the brain no longer being able to do things. And chronic pain falls right into these challenges. The Study I wanted to speak with Brendon after reading a study published in the journal Brain Sciences called “My Hand Is Different”: Altered Body Perception in Stroke Survivors with Chronic Pain. It's a fascinating look at how stroke survivors with chronic pain develop a false image of the affected hand. Our results support the hypothesis that individuals with sub-acute and chronic stroke who experience chronic pain are more likely to report changes in body perception (as indicated by presence of alterations in perceived hand size) than those without pain. Further, the frequency of altered body perception of the hand, and strength of the association were greater when the region included the hand. We've talked about the homunculus in previous episodes, and you can read more about the idea of the homunculus in this Strokecast article. Basically, the homunculus is a representation of the amount of neuronal real estate taken up by different body parts based on how much we use them and how we use them. For example, the thumb will occupy more space in the brain that the elbow. After stroke, our homunculus can undergo changes based on the injury and our new use patterns for our body. And among those changes are how we feel pain.  This study provides useful information in understanding that those changes take place. It reinforces the idea that pain is related to homuncular perceptions. And it further supports the perfect storm of chronic pain causes that we discussed in the episode. Hack of the Week Brendon's hack is to get into meaningful activities that bring you joy. Sort of like how Tawnie in the previous episode got into Mermaiding. There are lots of reasons to focus on activities like this -- whether that's volunteering in a community, playing a sport, creating art, developing a podcast or something else. Doing something deliberate and planning it gives us something to look forward to. Having a reason to get out of bed is super important, not only for stroke recovery, but for life in general. Making progress, striving, or even just doing something to improve your life and mood -- to bring joy is a powerful motivator to keep going. And for some folks, that means to just get to the next day. For other folks it's a way to change the world. Pursuing activities that bring genuine joy is a good thing in and of itself. But as Brendon points out, it has biological implications, too. It opens the proverbial "drug cabinet" in our brains to drive increased dopamine. This drives learning, which is the essence of stroke recovery -- teaching the brain to do the functions the dead brain cells used to do. Dopamine also drives the production of Gaba. And Gaba works to turn down the body's sensitivity to irrelevant information. Essentially, it helps the body inhibit some of the sensations that cause problems after stroke. Pursuing activities that drive joy addresses the challenges of stroke on multiple levels. Links Where do we go from here? To learn more about Brendon and see more of his research, visit his profile here. Share this episode with someone you know by giving the, the link http://Strokecast.com/pain. Subscribe to the Strokecast newsletter for periodic updates. Don't get best…get better More thoughts from Brendon

Tawnie the Neuro Mermaid bled into her brain for a week before the doctors in Ohio took her seriously. When the neurosurgeons began treating her they were shocked she was still alive. Still, the hemorrhagic stroke ended her dual career paths in in bar tending and special education. Naturally, Tawnie came up with an alternative. She became a mermaid, an entrepreneur, and an advocate and supporter of other members of the stroke community. In this long overdue Strokecast interview, Tawnie shares her story of trying to get treatment, how she got into mermaiding, her experience with cannabis, and the power of the stroke community. If you don't see the audio player below, visit the original blog post on the Strokecast website here. Click here for a machine-generated transcript Who is Tawnie, the Neuro Mermaid? As Tawnie shares: At 28 I had a hemorrhagic stroke go misdiagnosed for a week. That's right I was bleeding in my brain 🧠 for a week so I have been documenting & sharing my recovery. As a former special education teacher I'm interested in retraining my brain, biohacking, & helping others become 1% better everyday. Working from home & running a business from my phone gives me the flexibility & support I've always wanted. I enjoy helping others do the same! I love sharing tips tricks & my life follow along & ask any questions 🤗 I look forward to connecting Https://msha.ke/tawniethemermaid Medical Records One of the challenges Tawnie had in getting her stroke diagnosed was a GIGO problem -- Garbage In, Garbage Out. The initial doctor she talked to failed to recognize her symptoms as a those indicating a stroke, and he made the notes in her records. That was the first problem. It was the garbage in. Then, as Tawnie sought the advice of other doctors, they referred to her initial records, took the garbage in as truth, and failed to do their own assessment of Tawnie's symptoms, and produced recommendations based on that initial assessment. Garbage out. It took a nurse who hadn't seen Tawnie's medical records to recognize that she was having the medical emergency that would ultimately lead to a helicopter evacuation. In the US, at least, your medical records are yours. You are entitled to them. If you use the popular My Chart patient portal, you may have direct access to them. If not, you can reach out to your hospital, doctor's office, or other medical practitioners, and get copies of them. You can also get copies of your scans, X-rays, MRIs, etc. The most important reason to get them is so you know what is actually in them. Whether you can correct them is another matter, but if there is incorrect information in them, you should know about it so you can give that context in future conversations. The information in your records may impact future treatment. Nake sure it's not garbage. Migraines Migraines suck. I think we can all agree on that. So far I've only had one, I think. It was in the hospital after stroke. I felt my vision narrowing at the edges. It reminded me of how my vision would be impacted the flash cube in the Kodak Instamatic in the 1970s. Of course Tawnie's life long migraines were much more severe. She did get treatment for them, but no one checked for the aneurysm that was waiting to rupture. Tawnie powered through. Carmen De La Paz also experienced migraines for years before her stroke. She thought they were just dehydration so she would make a habit of drinking more water to address them -- until one day one of them ruptured. Sometimes the cause of a migraine is an aneurysm in a blood vessel. Caught early, aneurysms can be treated before they turn into debilitating hemorrhagic strokes. The patient needs to seek treatment, though. The doctor has to order tests, like an MRA, and the insurance company has to agree to pay for it. In Tawnie's case, the first two things happened. The insurance company failed by refusing to approve the scan that could have prevented Tawnie's stroke. You Look Fine! Many people will tell a survivor things like: You look great! You'd never know you had a stroke! Looks like you're all better now!! When people say these things they usually mean well. In reality, though, they can feel quite hurtful. Many survivors live with invisible disabilities -- cognitive, emotional, communication and other challenges that other folks can't see. Statements like those above ignore these challenges. After a few months, outward signs of the stroke may have dissipated, but internal struggles remain. Compliments like these invalidate and undermine the challenges that may still be part of our lives. They also make it easier for folks to blame us for being "lazy" when we have a high-neurofatigue day and simply need more sleep. Mermaids Tawnie embraced mermaiding. There is a community online of folks who put on tails and fins. They lounge around the pool or go swimming with their tails and celebrate the life style and community. It's interesting to have an episode with Tawnie the Neuro Mermaid right after I came back from the JoCo Cruise with its own substantial pod of mermaids. Tawnie's motive for becoming a mermaid is a great approach. The challenge with returning to a hobby after stroke is that you remember how well you used to do it. And if your ability to perform the same task is impacted by your stroke, it's frustrating. With a new hobby, though, as part of your new life, you don't have a pre stroke version of the experience to compare it with. So pick up a new hobby and start from scratch. You can only get better at it. Survivor Sundays Each Sunday, Tawnie joins Maddi Niebanck for Survivor Sundays on Instagram. It's an informal live show that gives Tawnie and Maddi the opportunity to connect with each other and the broader stroke community. It's an open forum for folks to share their experiences and ask questions. It's one of the positive examples of what social media can do in our lives. It lets people who need to connect interact with each other. And that's just what many of us need after stroke. To join Tawnie and Maddi, simply follow them on Instagram at @TawnieTheNeuroMermaid and @MaddisStrokeOfLuck. The show was also pivotal in Tawnie's decision to go public about her use of cannabis after stroke. Folks would ask about it during live broadcasts, and Tawnie would follow up in private afterwards. Eventually, she decided it would be better to simply be more straightforward about her experience. Budtenders and Weedmaps I did learn a new word in this episode: Budtenders. These are the folks that work at the legal medical and recreational marijuana dispensaries in states where it is legal. I just like the wordplay on bartenders. So what should you do about cannabis or marijuana? First, ask your doctor or medical team. Due to the fuzzy legal status they might not be able to tell you much. You can ask about the latest research, or ask if it is specifically contraindicated for any of the medication you take. Beyond that, the budtenders in the dispensaries can provide a wealth of information about the products available in your particular community. To find a dispensary, if it's legal in your community, Tawnie recommends Weedmaps. It's like a Yelp for cannabis. It’s a place for you to do additional research. Since I live in Washington state, I asked my doctor about it while I was inpatient. Granted this was 5.5 years ago so recommendations may have changed. This doctor said, basically, "If it's not already part of your lifestyle, now is not the time to start." This doctor also said that if I was have issues with appetite or nausea their recommendation might be different. So if you're interested in exploring cannabis, check with your doctors, talk with other members of the community who do choose to partake, consult with tools like Weedmaps and the budtenders in your area. Whatever decision you make, do the work to make sure it's the right one. Hack of the Week Tawnie has a busy life and lives with executive function disabilities brought on by her stroke. She's developed quite the collection of tools to help her navigate this life. First, she relies heavily on calendars, alarms, and notes on her phone. It's a great tool to outsource those brain functions that were impacted by the stroke. Tawnie is also a big believer in journaling. She does this both in writing and online. Chronicling her recovery on Instagram has been a way for her to see her own improvement, stay connected with her journey, try new things, and share the results with the community. You don't have to share as publicly as Tawnie does, though. Use your phone to take pictures, record video, record audio, make notes, and more. The further you get in your recovery, the more valuable these resources become. Simply looking back at these records shows us how far we've come. Tawnie also echoes what Kristen Aguirre told us a few years back, and what other survivors have found helpful. Practice gratitude. We're here, and that's a start. Looking for things in our life to be grateful for can help reframe our experiences and inspire more hope for the days to come while making the present more pleasant. Recovery is not an easy path. It takes work and time, and Tawnie talks about how you need to put in the time and energy to retrain your brain. There's no shortcut. You have to do the work Finally, one of the most important things Tawnie suggests doing is to reach out to the community. That could be a local support group. It could be an online community. It could be following the various stroke-related hashtags on social media. It could be listening to the various stroke-related podcasts out there. Or it could be joining live broadcasts on Instagram, like the Survivor Sundays that Tawnie and Maddi do. Links Where do we go from here? Follow Tawnie on Instagram at http://Instagram.com/TawnieTheNeuroMermaid Share this episode with someone you know by giving them the link http://Strokecast.com/TawnieTheNeuroMermaid Suscribe to the Strokecast newsletter at http://Strokecast.com/News Don't get best...get better More thoughts from Tawnie

It's one thing to have a stroke in an urban center surrounded by hospitals and ambulances. It's another experience altogether when you're at a snowy ski resort in a remote Canadian town. You can't call the caretaker because you are the caretaker, and your only connection to the outside world is a Satellite phone you left in the office. That was June Hawkins' experience as the dark specter of high blood pressure unleashed a cavalcade on emboli into her brain. In this episode, she shares the details of her story and how she's been writing her way to recovery. If you don't see the audio player below, click here to go to the original blog post. Click here for a machine-generated transcript Who is June Hawkins? June’s heart has always drawn her towards living life as an adventurer.  She has been a mountain guide, marathon runner and canoeist, mother of two children and program coordinator of a provincial crisis line. But her lifelong passion has always been cross country skiing. She developed and operated what became a one of the most successful ski schools in Canada, attracting skiers from across North America. June possesses the unique ability to make people feel relaxed and welcomed and considers her biggest accomplishment is that of teaching a fearful beginner skier the joy of getting down a hill safely. She had her stroke early in the morning of February 1, 2021. She was living and working for the winter at Nipika Mountain Resort in British Columbia, Canada as the on-site custodian and ski instructor. June says her stroke journey has blessed her with the time and the ability to continue with her other passion: writing. ​June’s recovery journey has provided a rich world from which to write and her hope is to speak to survivors using their language and to educate others about stroke using theirs. Nature of writing June found writing to be a great way to clear her own head. Navigating the world can be more complex after stroke and reducing the noise both coming in from the outside and the noise generated by our own thoughts. Writing can get that stuff out of the way. But where do you start? I find simply writing long to do lists helps, even if I never use the list. It's a great way to get started. Others find it helpful to write that they don't know what to write. The approach June takes in her program is to pass out writing prompts. These are questions or topics or themes to get you started. The great thing about writing prompts is that 5 people can get the same prompt and end up writing 7 different things and all of them are on topic. It's a place to explore your thoughts. With June's program, participants get to share their writing with other members of their cohort -- other brain injury survivors. Since it's ongoing for a series of weeks, it's also an opportunity to build relationships across distance with a diverse group of people who still share a major life event in common. And it's all with the stroke of a pen http://www.withastrokeofmypen.ca/ High Blood Pressure High blood pressure is the silent killer because it doesn't hurt. You can live with it for years as it slowly stiffens and damages the blood vessels in your heart and brain until a clot forms there, drifts there, or the wall of the vessel fails. The scale of damage high blood pressure does is astounding. In addition to being a leading cause of stroke, heart attack, and, therefore, disability and death at the individual level, it cost countries billions and trillions of dollars in lost productivity and increased health care costs. And you never know it's happening unless you check. So target 120/80 and work with your doctor to get there. Pick up a home monitor if you don't already have one. There cheap and may be the key to saving your life or the lives of people you care about. Stoicism June has been spending time diving into the philosophy of the Stoics. Stoicism has a rich tradition extending thousands of years and is underserved by pop culture interpretation of what it means to be stoic. It's based around four key values: Courage Temperance Justice Wisdom I think it's easy to see how those values can really come into play after stroke. They inform ways of thinking that can help us get through this new world. Will it work for you? Maybe. You can learn more at http://dailystoic.com 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 really appreciate it. Hack June cited two hacks for recovery. The first is simply to try typing with your affected side. It's not easy, but those repeated small motions are just the type of motion you want to get back. The second was to get a TV tray or breakfast-in-bed tray. This is a tray with short legs that you put over your lap. Sure, you could use it for croissants and coffee. June uses it for her computer. By using this platform and a keyboard, she reduces the shoulder and elbow strain that accompanies computer use after stroke. Links Where do we go from here? To learn more about June and her writing workshops, visit http://WithAStrokeOfMyPen.ca Share this episode with someone you know by giving them the link http://Strokecast.com/June Complete the Strokecast Listener survey at http://Strokecast.com/survey Don't get best…get better. More thoughts from June

Andrew Stopps call stroke "The Gentle Assassin." Like many (but not all) of us, Andrew found it remarkable that stroke did not hurt. That's often the case with an ischemic stroke. Mine didn't hurt either, and I found it remarkable at the time. It was a profoundly interesting experience. Lack of pain doesn't mean lack of impact though. Andrew found his music career suddenly upended and his mosaic career suddenly suspended as his husband rushed him to the hospital. He lost (for now) the ability to play the clarinet. He discovered unexpected laughter and tears. And it redirected his life. Andrew and I talk all about his encounter with the Gentle Assassin in this week's conversation. If you don't see the audio player below, click here to visit the original blog post.   Click here for a machine-generated transcript Who is Andrew Stopps? Andrew Stopps has taught music for over 20 years in Australia, UK and New Zealand. His teaching experience ranges from a woodwind instrumental teacher and band director in rural South Australia to Head of Music at the Australian International Performing Arts High School in Sydney. In 2009 he moved to New Zealand and in 2012 he was a finalist for the NEITA Excellence in Teaching Award. He is the founder of the Wellington City Concert Band, NZ Youth Symphonic Winds and the Wellington Band and Orchestra Festival. He is also the founder of the Hoa Project that provides support and mentoring to music teachers around New Zealand. He has been a composer and arranger since high school and his works are performed by ensembles around the world. He has travelled to Washington DC for the World Premiere of my work “Welcome to Aotearoa” for concert band in 2019. This year his “Middle Earth Suite” is to be world premiered in Melbourne, Florida.  In November 2021 he experienced a mini stroke immediately followed by a massive stroke. He has made a 98% recovery using music therapy, brain plasticity, and with the support of his husband.  He continues to compose and is currently writing his book "In One Stroke". You can connect and chat with Andrew at andrewstopps.com "I am Andrew Stopps." Before going to the hospital, while struggling with language and dexterity, and while his brain was dying, Andrew still had one thing to do. He needed to declare his identity. He needed to write "I am Andrew Stopps," before heading out the door. Our personality, individuality, and human existence is dependent on our brain. In the middle of a brain attack, like stroke or brain tumor, all of those things are at risk. Many survivors have to reckon with the idea that they will never be the way they were; this experience has made them a different person. Dr. Debra Meyerson explored this whole question in her book, "Identity Theft: Rediscovering Ourselves After Stroke."* I spoke with Debra and her husband about the topic and her book in 2019. You can listen to that discussion here. Diaphragm and Core When we talk about left or right side weakness after stroke we're not just talking about arms and legs. The same weakness can affect our core muscles -- the ones in our chest and abdomen. Weakness there can make it harder to sit up, leverage those muscles to make a big effort, impact our breathing or even hinder digestion and elimination. The diaphragm is the main muscle that controls breathing. When it moves smoothly in one way, we inhale. When it moves properly in the other way, we exhale. When stroke weakens it, things get screwey. Most of us never think about our diaphragms. Andrew is different. Because he's a musician with a career playing an instrument that relies heavily on breath control, he was already intimately familiar with the functioning of his diaphragm and how it behaved differently after stroke. It resulted in unusual laughter, among other things. Because he was familiar with it, he could also focus his efforts on regaining control. Additionally, consider our previous discussion about the homunculus. Andrew likely has more brain real estate dedicated to his breathing and diaphragm. Deliberate, repeated focus means cells were firing together more often. And the cells that fire together, wire together. Emotional Lability and PBA Emotion lability and pseudo bulbar affect also came up in our conversation. This condition is common after stroke. It refers to how survivors may find themselves crying at the slightest provocation or laughing at inappropriate times. It's a result of the physical damage to the brain. I've certainly experienced the unexpected tears, especially in the early days. Especially interesting was when I would find myself weeping from simple physical exertion in PT. It was crying without emotional context in my case. I didn't feel sad, just curious. This can be frightening to both the survivor and their family, especially if prior to the stroke, the survivor was a fairly stoic person who showed little emotion. Now when the cry for little or no reason, it can really share them and their care partners up. The question of, "Am I now a person that cries over TV commercials?" Further feeds into questions of identity after stroke. Hyperbaric Oxygen Therapy Hyperbaric oxygen therapy involves spending a chunk of time in a oxygen-rich, high pressure chamber every day. Andrew paid out of pocket for this treatment in New Zealand, and feels it helped his recovery. Of course, he's also not sure if it was the actual therapy that helped or if it was more the isolated meditation time that made the difference. The science doesn't provide much clarity. HBOT does help with infections, post-burn treatment, carbon monoxide poisoning, nitrogen bubbles in the blood (the bends), and some other conditions. The lack of any rigorous, controlled, double-blind studies on the effectiveness of HBOT after stroke is an issue. It's an expensive, time consuming process with no significant evidence that it works. I spoke with Dr. Michael Bennet a few years back about the treatment. You can listen to that conversation here. He's an expert in and advocate for HBOT. His assessment was that he wished it worked, but the evidence doesn't support it. So does it work? Maybe. Did the HBOT drive Andrew's recovery? Or was it just time spent in the chamber alone with his thoughts? Or did it help his recovery because he believed it would? We don't know. That's why we need more double-blind controlled studies to figure it out. In the meantime, we do know that it is safe for most folks. If a person has the money to spare and doing HBOT will not take time away from traditional PT, OT, and SLP, then, sure. Go for it. And I hope it's successful. Hack of the Week Andrew shared two hacks this week. The firs is about yawning. It's fascinating the way  a body with hemiparesis reacts when we yawn. Andrew found he could get some minor control once a yawn or stretch caused his hand and arm to respond. In my case, in the early days, a yawn would pop my affected arm right up and my fingers would go full jazz hands. It makes sense when you think about it. The brain damage from stroke may impact higher level brain functions, but yawning is a more fundamental bodily function controlled by the brain stem or acted upon by the spinal cord. And when we get that movement, look at it, focus on it, and try to take advantage of it. The first time you may not succeed, but the tenth or hundredth or thousandth may be a different story. I t reinforces the idea that your hand still works fine. You just don't have control of it…yet. Andrew's second hack is to become like a kindergartener. Organize your home carefully with everything put away in a deliberate manner. After stroke, you can't go rummaging effectively though overstuffed drawers and cabinets and expect to find what you want. You don't have the time, energy, spoons, or dexterity for that. A place for everything and everything in its place is how to approach home organization, like a kid's classroom. Plus, clutter scattered about the place is not a good idea when you have mobility challenges. 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. Links Where do we go from here? Check out Andrew's site, programs, and music by visiting http://AndrewStopps.com Share this episode with someone you know by giving them the link http://Strokecast.com/AndrewStopps Please complete the listener survey at http://Strokecast.com/survey Don't get best…get better. More thoughts from Andrew Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity.

Stroke research is important, and there's not enough of it. Finding funding for small and medium sized projects is hard and getting wider awareness of them is even harder. Collavidence seeks to change that. It's a Kickstarter-like platform for medical research, with a focus on stroke. Research teams Post research projects they are developing, and the public can choose to back them. They also participate in working groups with other experts to further refine the projects as the y pursue results. Collavidence Chief Knowledge Office Dr. Aravind Ganesh joins us in this episode to talk about the platform and how democratizing the research funding process can help us all. If you don't see the audio player below, visit the original post here, or look for the Strokecast in you podcast app. Click here for a machine-generated transcript Who is Dr. Aravind Ganesh? Dr. Aravind Ganesh Dr. Aravind Ganesh is a Vascular and Cognitive Neurologist. He completed his MD degree at the University of Calgary, followed by a DPhil in Clinical Neurosciences at the University of Oxford’s Centre for Prevention of Stroke and Dementia as a Rhodes scholar. He earned an Associate Fellowship from the United Kingdom’s Higher Education Academy through his teaching contributions at St John’s College (Oxford). He completed his neurology residency in Calgary, followed by a combined fellowship in stroke and cognitive neurology, funded by Alberta Innovates and the Canadian Institutes of Health Research. Dr. Ganesh is a Fellow of the Canadian Stroke Consortium, and is actively involved in the development of best-practice guidelines for stroke and dementia care. His clinical research is focused on the natural history, prevention, and treatment of stroke and cognitive impairment. He is passionate about medical education, and serves on the editorial boards of Neurology, Neurology: Clinical Practice, and Stroke. Should you back projects on Collavidence? Maybe. If you feel the project has value (or could have value), if it sounds like something you would like to support, if the team behind it seem credible, and if you can afford it, go for it! Contributions don't have to be large to be meaningful. Be aware that it's always possible a project won't work out. There are lots of things that can go wrong, just like on other crowd funding platforms like Kickstarter and Go Fund Me. Exercise caution, like you do with other financial concerns. If you want to have a concrete, direct impact on the research projects that can make life better for the stroke community, though, this might be a great way to do it. 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 This week's hack is more for researchers. That's to communicate with the community. Often researchers may pursue projects to address what they see as problems in the stroke field, and that's great. It's also important, though, to listen to the people they want to help. Does a research project address a problem member of the survivor community actually care about solving? A recurring theme from disability advocates is, "Nothing about us without us." That means before folks try to solve things for people with disabilities, they ought to actually communicate with people with disabilities. Don't try to solve a problem we don't have. And don't assume that solution created by just a group of abled folks will work or appeal to disabled folks. Get the input of people with disabilities, and involve us in the process. Hire disabled consultants and architects on projects benefiting the disabled. And keep in mind that accessible design is good design. Nothing about us without us. Links Where do we go from here? Check out some of the projects on Collavidence.com Share this episode with someone you know with this link: http://Strokecast.com/CrowdFundingResearch Complete the Strokecast listener survey at http://Strokecast.com/survey Don't get best…get better More thoughts from Dr. Aravind Ganesh

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

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

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

Paul Strikwerda is a voice over artist. You may have heard is voice in commercials and other projects. Now, he is also a stroke survivor. The stroke he suffered in his voice over booth engaged multiple primal fears (except for spiders) and is one of the more terrifying I've heard.  I'll save the details for the interview itself. The genesis of this episode is that I wanted an answer to the question, "Is voiceover a good career choice for a stroke survivor contending with disabilities?" I was referred to Paul, by Anne Ganguzza of the VO Boss podcast (another great resource for the VO field), and in this episode Paul and I discuss that question and so much more. If you don't see the audio player below, visit http://Strokecast.com/MSN/VoiceOver to listen to the conversation. Click here for a machine-generated transcript Who is Paul Strikwerda? Paul Strikwerda was born and grew up in the Netherlands. He studied music in college and began a career in radio after graduation. Life eventually took him to the United States and an unexpected series of events led him down the path of a voice over artist. Paul wanted to do more than read scripts for clients. He wanted to help other artists in the VO field. He would go on to write "Making Money In Your PJs: Freelancing for Voice-Overs and Other Solopreneurs"* and expand his blog on NetherVoice. He offers an unvarnished view of what life in the VO field is like and what newcomers need to watch out for. For those who want to grow their skills as voice over artists and voice over business people (you have to be both to succeed) Paul offers coaching programs. As he says on https://www.nethervoice.com/coaching/: It’s not enough to be outstanding. You need to stand out. Voice overs are the invisibles of the entertainment industry. Competition is increasing, and clients aren’t going to book you if they don’t know you exist. You need a plan to put you on the map, so clients can find you, hear you, and hire you. Let me be your visibility coach, and help you attract the jobs you’re dreaming of doing. What is the Voice Over field? The Voice Over industry is one most people don't think about, but it is one that we've encountered throughout our lives. Every time we hear a narrator on TV or listen to an audio book or hear a corporate voice mail system or listen to the introduction to this show (Thanks, Tim!) or complete eLearning with a person speaking, or learn about pancakes, we are listening to a voice over artist at work. https://youtu.be/FEelYk8y_O4 The breadth of the field is fascinating. The industry itself is facing some growing pains with technology and the increase in computer generated voices. There are some growing pains there. Technology has also led to a democratization of the field in some respects. Microphones and computers for editing have gotten cheaper and more widely available. Home studios are within reach of more people. Some of the same technology trends that drive podcasts drive voice over work Lots  of people toy with the idea of becoming voiceover artists so, especially at the entry level, there is a ton of competition. As Paul explains, though, it takes a lot more to be successful than the ability to speak into a microphone. A voice over artist needs to be a business person. The need to sell their services. The need to audition well. They need to write contracts and collect from clients. They need to have a handle on the assortment of ways they can license their voice. And they still need to act and edit and produce. If you are thinking about a career in voice over, and you're will to do all the stuff that goes along with it,  Paul's coaching services might be a good fit How does AFib cause stroke? The heart is made up of four chambers. Blood normally flows from the upper right to the lower right to the lungs to the upper left to the lower left and then on to the rest of the body. Moving it efficiently from one place to the next requires a precise rhythm -- the lub-dub of the human heart beat. When someone has AFib, or atrial fibrillation, it means the rhythm isn't quite right sometimes. Maybe different parts of the heart are out of sync, or part vibrates too fast or the heart rhythm itself fluctuates in an odd way. When this happens, blood doesn't always leave the chamber it’s in when it's supposed to. And when blood pools or collects in the heart when it shouldn't, it can start to coagulate. It forms clots. Then when the heart beats one of those clots that formed due to AFib can shoot off to another part of the body. If that clot makes it to the brain and gets stuck in a blood vessel, you have an ischemic stroke. So how do you treat it? Well, first you have to find it. Since it is irregular, that's not always easy. Some people will get a surgically installed monitor that will track their heart rhythm for a couple years. Others (like me) will have to wear a device like a Zio patch for two weeks to look for abnormalities. Bill wearing a Zio patch to check for irregular heart rhythm. If doctors find or strongly suspect AFib affects a patient, they have a few treatment options. Blood thinners, or anticoagulants are one option. These medicals like Eliquis and Xarelto are more aggressive at stopping clots than antiplatelet medication like aspirin or Plavix (Clopidogrel). They require additional blood tests and monitoring and put the patient at greater risk of bleeding because that's exactly what their supposed to do. Paul had an ablation therapy. Doctors either freeze or burn some small amount of heart tissue. This disrupts the way electricity flows through the heart, which helps normalize the heartbeat. It's a fascinating technique and eliminated the problem for Paul. You can read more about the procedure from Johns Hopkins or from the Mayo clinic. Some people, if their unusual rhythm is too slow, may need a surgically implanted pacemaker to keep the heart moving enough blood quickly enough. As more people become aware of AFib and research continues, the future of treatment may change dramatically. In defense of social media A lot of people claim to hate social media. The conversation is even louder in December 2022 with Elon Musk's takeover of Twitter. Hate speech, privacy concerns, online bullying, the growth of influencer culture, and more have all made it fashionable to hate on social media. And there are a lot of problems with it. By allowing folks with fringe and extremist views to connect and validate one another's views, it has likely allowed those views to become more common. I'm not defending that. That same mechanism, though, has allowed people with disabilities to find other like-minded folks. Stroke and other disabling conditions are isolating. Appearances of disabled people in media are still rare. After stroke, many folks leave their jobs, removing another vector for social experience. Friends and family members may pull back from stroke survivors either because the survivor is no longer able to participate in the same activities or because they are uncomfortable around a person with disabilities. Or because the survivor is a living reminder that they could find themselves in the same situation. And disabilities themselves make social connection hard. Aphasia impacts conversation. Mobility challenges make it harder to go someplace to meet someone. Vision or equilibrium challenges may make it unsafe to drive. That's to say nothing of the assortment of cognitive, sensory processing, emotional, and fatigue related challenges a survivor may live with. And then we can look beyond the stroke world to our neuro cousins in the MS and TBI communities, and beyond that into the broader world of people with disability. Despite the billion+ disabled people in the world, it's easy to feel the despair of feeling alone. Social media changes that. Or at least helps with it. People with disabilities are able to connect with one another across the street and around the world. There is power in the shared experience -- of finding someone going through a similar experience. There's power and hope in being able to support each other -- to build on the success of others to drive our own recovery and that of others in the community. To be able to raise a voice and say, "This is my hidden reality!" To be able to see that the way someone else treats us may not be right and to have that reinforced by people all over the country. There's power in giving everyone a literal or metaphorical voice. To demonstrate to the world that we're here and we're not going anywhere. Whether it's on Facebook, Instagram, Tik Tok, IRC, MUDDs, Discord, YouTube, or whatever, we can leverage those platforms to empower us to live our best lives. Or to share a simple message of support. Look for communities that resonate with you in a supportive fashion. Follow hashtags like these to start and try others to build your community: #Stroke #StrokeAwareness #StrokeRecovery #BrainInjury #LifeAfterStroke #Aphasia #Mindset #CripTheVote #Disability Social media allows us to connect and that connection is so important to getting more out of life. BEFAST & AHORA Raising voices in social media isn't just about supporting our own lives; it's about saving others. And you can help save other's lives by sharing the stroke warning signs far and wide. We know time is essential. We also know that over the past 20 years or so there have been tremendous changes in stroke treatment - new ways to save lives and reduce the severity of disability. That, of course, assumes treatment begins as soon as possible. And to make that happen, people need to recognize that a stroke is happening and contact emergency services immediately. So share the stroke warning signs in English and Spanish far and wide -- BE FAST and AHORA. And if you have the warning signs to share in another language, share those, too. June Hawkins writing workshop June Hawkins is a stroke survivor in Canada helps stroke survivors connect (or reconnect) with their creativity through the power of writing. Her program is called, "With a Stroke of my Pen" and with her cofacilitator, writing prompts, and exercises she helps other survivors explore their world in writing. The next cohort starts soon. To learn more, visit http://www.withastrokeofmypen.ca/ Hack of the Week There are two things that Paul found critical to going through recovery and living with disability. The first is to have a dedicated partner who can advocate for you. It's not easy to navigate the healthcare industry with sudden, unexpected brain damage, and a supportive partner makes a huge difference. Finding the right person to be your partner in life, of course, is not always the easiest task. The other element which may be easier to cultivate is to develop a "stubborn positivity." The right action-oriented attitude is what gets us developing the right mindset for recovery. It helps us expect to get better and it drives us to do the work -- the exercises, the metal health care, the repetitions, etc. -- that will ultimately help us drive the neuroplastic change in the brain that empowers recovery. Links Where do we go from here? Check out Paul's blog and website at http://NetherVoice.com Share this episode with someone you know by giving them the link http://Strokecast.com/VoiceOver Check out June's writing course at http://www.withastrokeofmypen.ca/ Don't get best…get better More thoughts from Paul