I read a study recently in Biological Research for Nursing titled "Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors". Big title, but the study results struck a chord with me. If you look after a stroke patient, you have an increased likelihood of being depressed.
The study looked at the markers for stress in caregivers - cortisol levels, anxiety, insomnia - and could see increased levels in caregivers versus the general population. On average, in their study, caregivers for stroke patients worked about fifty hours a week providing that care. For many of them, that's over and above any job that they have, or any time taken to look after themselves.
On a personal note, I can see how this wears on the caregiver. My wife said she would lie awake at night listening to me breathe - hoping it wouldn't stop. And constantly being concerned about travelling up and down stairs. Or unloading the dishwasher. Or going down the street on my own.
I was fortunate. Within a few months I was able to look after myself for the most part, and my wife didn't have the immediate stress of going back to work. Many don't have that luxury.
Their patients cannot manage on their own - from going to the washroom, to having a bath or shower, to feeding themselves, basically everything I now take for granted (and my wife no longer lies awake listening to me breathe).
The point of all this is lets make sure that we recognize the tremendous strain and stress put on the caregivers in our society. We need to look out for their best interests, as well as for those of their patients.
Vitamin D Reduces Stroke Risk
A study out of Honolulu, Hawaii, published in the AHA Journal - Stroke, looked at the stroke incidence of 8006 Japanese-American men over the course of 34 years (a longitudinal study - or "repeated observations of the same variables over long periods of time").
What they found was that over the 34 years, 960 of the subjects became stroke sufferers. What researchers discovered when examining the variables in the data, is that Vitamin D levels in the stroke patients were, on average, significantly lower than in those who didn't have a stroke:
What they found was that over the 34 years, 960 of the subjects became stroke sufferers. What researchers discovered when examining the variables in the data, is that Vitamin D levels in the stroke patients were, on average, significantly lower than in those who didn't have a stroke:
"Age-adjusted rates of incident stroke were significantly higher in the lowest dietary vitamin D quartile compared with the highest. Using Cox regression, adjusting for age, total kilocalories, body mass index, hypertension, diabetes mellitus, pack-years smoking, physical activity index, serum cholesterol, and alcohol intake, those in the lowest quartile had a significantly increased risk of incident strokewith the highest as the reference. We found no significant associations between dietary vitamin D and hemorrhagic stroke"As luck would have it, I have ramped up my Vitamin D intake to 4000IU/day to try and combat my insomnia issues (I heard it might help - so at this point I'm trying everything). Regardless of how it changes my sleep, I may now continue to take it based on this information..
Note that some paranthetical comments were removed in this quote.
The Reason Behind My Stroke - Occam's Razor Edition
There's something called Occam's Razor, used often in science and philosophy. The thinking goes something like this:
"other things being equal, a simpler explanation is better than a more complex one "
Ptolemy, almost two thousand years ago, stated:
"We consider it a good principle to explain the phenomena by the simplest hypothesis possible"
In my case, I was a young man of 49 in otherwise excellent health when I had my stroke. It was preceded by open heart surgery three years earlier - where some small but dangerous plaque-filled blockages were found. I was a vegetarian, slim, a person who exercised all the time, who had fantastic blood cholesterol profiles.
But the stroke happened anyway.
The neurologists, cardiologists, internists, and my family doctor doctor all shrugged their shoulders after every test came back negative (CAT scans, MRI's, Spinal Taps, and litres of blood-work). "Bad luck" is what they said. I lived with this diagnosis for two years, always searching for a better, simpler explanation.
I believe I have found it.
The Occam's Razor Version Of My Stroke
Not a single health professional in my journey through the system ever specifically asked what I ate. I think this will turn out to be the key.
I became vegetarian about thirteen years earlier, ironically to avoid the fate of my father and grandfather - who both suffered heart attacks in their sixties.
For the first several years I shunned meat in any form. During the last few years I became more flexible, starting to encorporate fish about once a week, and would have red meat about once a month.
One thing ran common along those thirteen years, though. I made up for the lack of fat in my diet (because everyone knows that low-fat was the pinnacle of good health!) with a significant increase in carbohydrates. Specifically, starchy carbohydrates. Things like whole-wheat bread, whole-wheat cereal, and potatoes. If I ate a carb, it was a "healthy" one.
It got so that my daughter often commented "Dad, you eat a lot of carbs".
Through nothing more than serendipity, I stumbled upon a link on the internet one day that talked about the dangers of carbs. I read further and found lots of information - a lot of it a part of a Paleo Diet thread I followed for a while. I also read the books by Gary Taubes and downloaded essays from famous heart surgeons.
The process as I now understand it, is that carbs (specifically, grains) cause an increased, frequent, damaging insulin response when you eat them. This constant assault by a hormone that was never meant to be exercised this often causes stress and damage to the insides of our arteries, causing the plaques that we desperately want to avoid. It is the root of something we now call "metabolic syndrome". I had the low HDL (even with statins and niacin, never above 1.2 mmol/litre - or 46 mg/dl in USA) that's a significant marker of this syndrome, even though my weight was OK.
Cholesterol isn't the bad guy it has been made out to be. A specific kind of fat in the blood (very low density lipoproteins or VLDL) are the bad guys. And they're brought on by, you guessed it, excess carbohydrates. These same carbs lower our protective, good cholesterol - HDL. Total cholesterol and LDL have almost nothing to do with heart disease and stroke. It's the inflammation in our systems caused by the frequent insulin spikes, in combination with the VLDL particles that cause the problems.
So the Occam's Razor explanation for my heart disease and subsequent stroke, despite an excellent lifestyle and blood cholesterol profile, is now the very best explanation that I can come up with for what's happened to me.
"Too many carbs, and grains specifically, lead to metabolic syndrome - which eventually can lead to heart disease and stroke".
But knowing (or hoping I know) what happened and why is only half the issue. The other half is "so what am I going to do about it?".
The Solution
The solution is quite easy. Cut the carbs as much as I can. From about 60-70% of the calories I consumed, to about 20% (100 grams/day = 400 calories). This is best accomplished with a modified Paleo-style diet.
I have been on this diet for about four months now, and have seen the following changes:
- Through no plan of my own, my weight has dropped to 145-150lbs. It has been as high as 185lbs. Interestingly when I was exercising intensely and eating a strict vegetarian diet I could only get my weight down to 152lbs. I cannot run any longer (after affect of the stroke), so am unable to get any intense exercise. But the weight just falls off.
- My bloodwork now looks unusual by traditional standards. Total cholesterol and LDL are high. But so is HDL - higher than it's ever been. Triglycerides are the lowest they've ever been. The new thinking is that this ratio (HDL/Trig) is the important one - and mine is now fantastic.
- I now eat meat almost every day. And a tremendous amount of fat. It all seems quite outrageous.
- I am off all drugs. After seeing the bloodwork, I have re-incorporated 1000mg of fish oil (for inflamation) and 500mg of niacin (to raise HDL even further if possible) into every day.
Not me. I want to live!
National Stroke Association - A Resource
The National Stroke Association is a US-based organization who's "mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke."
This is a fancy way of saying "we help stroke survivors, and help minimize the chances that you'll have one".
I am a stroke survivor, and although I live in Canada, the infrastructure offered by such associations is appreciated - it is a fountain of knowledge. When I had my stroke, I knew nothing about stroke, and didn't know anyone close (in family, friendship, or proximity) that had suffered one. So I kind of had to go it alone.
Fortunately for me, after a couple of weeks in the Neurology ward of our major-trauma hospital, I was transferred to the rehab wing of a much smaller, closer hospital - handier to home and easier for family and friends to visit.
There are, I think, two really important therapies in getting better (different, but better) after a stroke:
This is a fancy way of saying "we help stroke survivors, and help minimize the chances that you'll have one".
I am a stroke survivor, and although I live in Canada, the infrastructure offered by such associations is appreciated - it is a fountain of knowledge. When I had my stroke, I knew nothing about stroke, and didn't know anyone close (in family, friendship, or proximity) that had suffered one. So I kind of had to go it alone.
Fortunately for me, after a couple of weeks in the Neurology ward of our major-trauma hospital, I was transferred to the rehab wing of a much smaller, closer hospital - handier to home and easier for family and friends to visit.
There are, I think, two really important therapies in getting better (different, but better) after a stroke:
- Family and friends that come to visit. You're going to be in rehab for weeks or months (for me, it was 93 days total - I'd say about 70 of those in rehab), and the more visitors you have, the better. It caused some minor embarrassment to me as I had a visitor(s) every single day of my stay. Some were not so lucky ... there was a young man on my ward who had one visitor during the 70 days I was there. Can you say "depression"?
- Knowledge is king. Knowing what's happening to you, what has happened to you, and what will likely happen in the future are powerful things. It gives you a sense of control when you most need it. Websites like the National Stroke Association are really helpful in helping you gain that knowledge. When the neurologist comes to your bedside and you have intelligent questions to ask - they engage, and I found they would spend the extra time with you. A smart, engaged patient gets the attention of good doctors and nurses.
TIA's or mini strokes
Mini strokes or little strokes are what people are referring to when they have a Transient Ischemic Attack, or TIA. It's when a person has stroke-like symptoms lasting up to two hours.
TIA's can be quite varied, but normally present themselves in one of these ways:
The next day, on the phone to one of my work colleagues, I found that my handwriting was like chicken-scratch, that I made dozens of errors in my typing (of which I am normally fast and accurate) and there was a slight slurring of my voice. I went to my doctor and he got me into a stroke clinic right away. I was evaluated, and it was determined that my TIA must have been a very minor stroke. All the symptoms were gone in a few days, and everything returned to normal. Fifteen months later I had a much more major stroke that affected things in a much more serious and long-term way.
There's not much you can do about a TIA except get yourself to a doctor or emergency room. They can evaluate you, and try to make sure that your TIA doesn't turn into a full blown stroke (for me, they tried everything they could think of - I have no risk factors - but it happened anyways)...
TIA's can be quite varied, but normally present themselves in one of these ways:
- Muscle weakness, normally on one side of the body - like your arm, your leg, or your face.
- Tingling or numbness on one side of your body.
- Difficulty swallowing.
- Difficulty reading or writing.
- Trouble with speech - either speaking yourself, or understanding what someone else is saying.
- Mood changes, personality changes.
- Problems with your vision - could be double vision or partial or full loss of sight.
- Sudden loss of memory or confusion.
- Experiencing a change in sensation - pain, temperature, hearing, pressure, etc.
- An abnormal change in your alertness - all the way to being asleep or unconscious - or the inability to maintain focus.
- Vertigo or dizziness.
- Clumsiness, uncoordinated - hard to walk. Balance and coordination issues.
- Can't recognize external stimulus - your senses aren't working right.Control of body functions - bladder and bowels.
The next day, on the phone to one of my work colleagues, I found that my handwriting was like chicken-scratch, that I made dozens of errors in my typing (of which I am normally fast and accurate) and there was a slight slurring of my voice. I went to my doctor and he got me into a stroke clinic right away. I was evaluated, and it was determined that my TIA must have been a very minor stroke. All the symptoms were gone in a few days, and everything returned to normal. Fifteen months later I had a much more major stroke that affected things in a much more serious and long-term way.
There's not much you can do about a TIA except get yourself to a doctor or emergency room. They can evaluate you, and try to make sure that your TIA doesn't turn into a full blown stroke (for me, they tried everything they could think of - I have no risk factors - but it happened anyways)...
Stroke symptoms for men
Heart disease (heart attack) symptoms for men are very different than for women - men tend to report different "sensations" than women, although the underlying issue is exactly the same.
Although most strokes are basically the same thing as a heart attack - only in your head instead of in your heart, the stroke symptoms for men and the stroke symptoms for women are the same. If you experience any one of these symptoms, don't delay. Go to the hospital by ambulance right away - time equals brain cells. The sooner you get some aggressive stroke treatment (TPA, the "clot busting drug" comes to mind), the better the chances you have of limiting the damage a stroke can do. And boy, can it ever do damage.
I've had both open heart surgery (double bypass), but fortunately it happened before I had a heart attack - and I've had a relatively minor stroke. Let me tell you that the heart surgery was a cake-walk compared to the stroke. 93 days in a hospital, re-learning how to walk and to talk, and still unable to do some things I used to - like run and swim. And my stroke was minor according to the NIH Stroke Scale.
So on to the symptoms. I like to remember the FAST method of recognizing a stroke:
F stands for face. Try to smile in a mirror. If one side of your face doesn't respond, or droops, you may be having a stroke. Call 911.
A stands for arms. Stretch both arms out before you, palms up. If one arm falls or drifts down, or cannot get up in the first place, you may be having a stroke. Call 911.
S stands for speech. Speak to someone if you can. If your words are slurred, in the wrong order, make no sense, or you can't speak at all, you may be having a stroke. Call 911.
T stands for time. Time is brain cells. If any of the FAS symptoms appear, don't question yourself (this is also typical - pretending nothing is wrong), call 911 and get an ambulance right away!
Although most strokes are basically the same thing as a heart attack - only in your head instead of in your heart, the stroke symptoms for men and the stroke symptoms for women are the same. If you experience any one of these symptoms, don't delay. Go to the hospital by ambulance right away - time equals brain cells. The sooner you get some aggressive stroke treatment (TPA, the "clot busting drug" comes to mind), the better the chances you have of limiting the damage a stroke can do. And boy, can it ever do damage.
I've had both open heart surgery (double bypass), but fortunately it happened before I had a heart attack - and I've had a relatively minor stroke. Let me tell you that the heart surgery was a cake-walk compared to the stroke. 93 days in a hospital, re-learning how to walk and to talk, and still unable to do some things I used to - like run and swim. And my stroke was minor according to the NIH Stroke Scale.
So on to the symptoms. I like to remember the FAST method of recognizing a stroke:
F stands for face. Try to smile in a mirror. If one side of your face doesn't respond, or droops, you may be having a stroke. Call 911.
A stands for arms. Stretch both arms out before you, palms up. If one arm falls or drifts down, or cannot get up in the first place, you may be having a stroke. Call 911.
S stands for speech. Speak to someone if you can. If your words are slurred, in the wrong order, make no sense, or you can't speak at all, you may be having a stroke. Call 911.
T stands for time. Time is brain cells. If any of the FAS symptoms appear, don't question yourself (this is also typical - pretending nothing is wrong), call 911 and get an ambulance right away!
NIH Stroke Scale - "scoring a stroke"
When I entered the Emergency Room after suffering a stroke, and having partial paralysis and some slurred speech, I wondered why they kept asking me such obscure questions. There seemed to be no particular rhyme or reason to their questioning, and it took until now, some two years later, to understand just what they were doing.
They were following the National Institutes of Health (NIH) Stroke Scoring methodology. This is often called the NIH Stroke Scale, and it is a scale from 1 to 30 on how severe your stroke is at the time it is evaluated.
A score of 25 or more means that your stroke is considered "severe", and a score of less than 4 is considered minor in comparison.
The major things they look for in this evaluation are:
They were following the National Institutes of Health (NIH) Stroke Scoring methodology. This is often called the NIH Stroke Scale, and it is a scale from 1 to 30 on how severe your stroke is at the time it is evaluated.
A score of 25 or more means that your stroke is considered "severe", and a score of less than 4 is considered minor in comparison.
The major things they look for in this evaluation are:
- Level of consciousness . Scored from 0 (keenly alert) to 3 (unresponsive physically and mentally).
- Asking what month it is and what age you are. Score a 0 if you answer both correctly, and 1 each for a wrong answer to either question.
- Open and close your eyes, and clench with your non-affected hand. Again, 0 if you do both, 1 each if you cannot do either.
- Test your gaze with your eyes. The doctors will have a score of 0 if everything is normal, and 1 or 2 depending on what they find.
- There are a couple of other visual tests they run, also scoring from 0 (normal) to 2.
- They will measure facial paralysis (scale 0 to 2).
- On a scale of 0 (normal) to 4, they will measure both your arm and leg movement/paralysis.
- They will measure ataxia or your ability to coordinate movement - by touching your finger to your nose and to an outstretched point (like the doctor's finger) - maybe do the same with your leg as well. Measure 0 to 2.
- The doctors will test your sensory perception - applying a small prick to your affected limbs. Measure 0 to 2.
- They will run a couple of tests on your speech. Is it slurred - how severe? Are you comprehensible and do you comprehend? The first is measured 0-2, the second 0-3.
- Finally, they will evaluate how attentive you are. Do you suffer from neglect to your surroundings? Are you "out of it"? Score 0-2 again.
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