Strokecast: The Stroke Podcast for Survivors, Clinicians, Care Partners, and all our Brain Injury Colleagues

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: 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...

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...

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...

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...

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. 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...

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...

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...

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...

Memory is not as reliable as we like to think it is. And that's not a stroke thing. It's just the nature of memory. Of course a stroke can impact memory as well. It can hurt our short-term memory, like in Christine Lee's stroke ( http://Strokecast.com/Christine). It can impact whether or not we can "remember" vocabulary, like in the case of aphasia. We may find our memory stronger earlier in the day than later in the day. This week, I speak with the host of the Brain Science podcast and member of the Podcast Hall of Fame, Dr. Ginger Campbell about ow memory work in the non-damaged brain. We explore some of the misconceptions that govern memory , its accuracy, and even how it impacts the criminal justice system. If you don't see the audio player below, you can listen to the conversation at http://Strokecast.com/MSN/BrainScience Click here for a machine-generated transcript Who is Dr. Ginger Campbell? Dr. Virginia “Ginger” Campbell is a physician, author, and science communicator. She is the author of “Are You Sure: The Unconscious Origins of Certainty”* and she is a member of the Podcast Hall of Fame (2022). Dr. Campbell began podcasting in 2006 when she launched two shows: Brain Science and Books and Ideas. Both feature interviews with scientists, but Books and Ideas includes more diverse guests including science fiction writers. In 2018 she launched Graying Rainbows, which took her interview skills to a more personal level. Brain Science is still going strong and is widely regarded as the best podcast about neuroscience. Dr. Campbell spent over 20 years as an emergency physician in rural Alabama. In 2014 she went back to the University of Alabama in Birmingham where she completed a Fellowship in Palliative Medicine. She now practices Palliative Medicine at the Veterans Administration Medical Center in Birmingham, AL, where she enjoys both patient care and teaching residents, fellows, and medical students. Dr. Campbell enjoys sharing her passion for science and especially neuroscience. Her goal is to make these topics accessible to people from all backgrounds. Memory is not a Recording One theme that comes up frequently is that the brain is not a computer and memory is not a recording. The dynamic nature of memory means that our "mental records" of events cand and are supposed to change. Each time we recall an event, we rewrite it. Maybe we add new data or interpretations. Maybe we purge less relevant details. The whole evolutionary purpose of memory is to keep us alive so we can reproduce and propagate our genes. Of course that's the evolutionary purpose of every aspect of our biology. Our existential, theological, spiritual, philosophical, or metaphysical purpose is different, but that's a separate discussion. Memory is not intended to provide an accurate, societal record of all events. It's meant to help us survive. Criminal Justice Eyewitness testimony and stranger identification is the least reliable form of testimony in court. In addition to challenges like cross-race identification, even our most traumatic memories lack accuracy. Again, the memory is there to keep us alive, not to ensure the right person goes to jail. We often read about the flaws of eyewitness testimony. The fact is memory is often not accurate enough to convict someone beyond a reasonable doubt (the standard in the US). Fortunately, the proliferation of dash cams, cell, phone recordings, and police body cams provide an often more accurate supplement to memory. And the advances in DNA identification and analysis provide a further level of certainty. There are likely still hundreds or thousands of people in prison around the world solely because of someone's memory. Is everyone who claims to be innocent actually innocent? Of course not. Are some of them innocent? Surely. Any assessments and accusations, especially about...

When most stroke survivors go home, that's not the end of recovery or therapy. They often get to go to an outpatient facility a few times a week to continue making progress with PT, OT, and speech therapy. It's great when that's feasible. Unfortunately, it can mean spending several hours to attend a 45 minute session. An it may require that not only from the survivor but also from a care partner. Transportation logistics, scheduling challenges, etc. can take energy that would better spent on recovery and rehab. But do we really need to travel? The pandemic radically sped up the adoption of telemedicine and remote healthcare. Facilities added infrastructure and patients learned to use Zoom and Teams. A lot of therapy -- especially speech therapy can be done online with a remote therapist. Lenora Edwards is a Speech Language Pathologist with Better Speech. Better Speech has more than 150 therapists around the US offering remote Speech Therapy. In this episode, Lenora tells us how this works, how it helps, and when remote therapy doesn't make sense. If you don't see the audio player below, visit http://Strokecast.com/MSN/BetterSpeech to listen to the conversation. Click herefor a machine-generated transcript Who is Lenora Edwards? Lenora Edwards is an ASHA board certified Speech-Language Pathologist. Throughout her career as a speech therapist, she has enjoyed treating and evaluating a wide variety of speech and language issues across the lifespan. Aphasia, Apraxia, and Dysarthria These are three common speech challenges after a stroke. Aphasia is trouble finding words. A person has all their thoughts, feelings, and smarts, but they just can't access the vocabulary to express themselves. They're not dumb, and they still have all their intellectual capability and processes. They just can't use words. In some cases, they can understand things fine; in others, they lose the ability to understand words, too. Sometimes they can read and write. Sometimes those functions break. Apraxia is a challenge of getting the words in the right order. Once you can access your words, and pull them off a metaphorical shelf, you still need to chain them together into sentences and paragraphs to communicate with other people. Dysarthria isn't a language issue itself; it's a speech issue. Dysarthria happens when we have trouble with the mechanics of speech -- tongue, larynx, jaw, and lip movements for example. This is what had for a little while. My hemiparesis wasn't just my arm and leg, but also the muscles on the left side of my face and mouth. It resulted is some slurring and mild pronunciation challenges. Overall, it was one of my milder deficits at the time. Most folks thought it cleared up in a couple weeks; I continued to notice it for 6 months. One fascinating aspect of all this is just how much goes into language and communication. There are so many different ways it can go wrong, it's a wonder anyone can speak at all. Adjective Sequence We learn our first language intuitively We pick it up as a child from those around us, cultural tools, our environment, and later school. We don't learn the rules first. We learn them after we've already been using them for much of our lives. In English, adjective sequence is one of those rules. Many of us heard or read the children's books about Clifford, the big, red dog. Just saying that phrase will trigger a memory for many folks. Even if this is the first time you've heard about Clifford, you understand what I mean. You may not be aware that by big, I mean house-sized, but you get the point. If I mention Clifford, the red, big dog, it seems wrong. And it is because in English (in the US, at least), size adjectives come before color adjectives. That's the rule. When did I learn this? Last year. Seriously. I never knew this was a rule before, but I "knew" it was...

More than a million people in the United States have been killed by COVID-19 in the past 3 years. The numbers would be much higher, but the vaccines were developed with amazing speed. Time and again, the vaccines have been shown to be safe and effective. Yet some people persist in claiming the mRNA vaccines are causing an epidemic of stroke. The data is clear. They do not. If you want to reduce your chances of stroke, get the vaccine. The new thing that causes stroke over the past few years is COVID-19 itself. If you want to decrease your chances of having a stroke (or another stroke) don't get a severe COVID-19 infection. And the simplest thing you can do to reduce your chances of getting a severe COVID-19 infection is to get the COVID-19 vaccine. If you do catch COVID-19 despite the vaccine, the data shows it will be much less severe and much less likely to be fatal. In addition to protecting yourself, you are also helping to protect others who may not be medically eligible to get the vaccine. The COVID-19 mRNA vaccines are saving lives every day. In this episode ... In this episode, I talk with data scientist and epidemiologist Dr. Remle Crowe about the research studies coming out now that show what we already knew from earlier research: the COVID-19 vaccine does not increase your risk stroke. We talk about several studies, and we talk about how you can do your own research on the credibility of these studies and evaluate how well they reflect the scientific reality of our world. In this post, you'll also find links to a bunch of these studies that you can read for yourself. Start by listening to this conversation. If you don't seed the audio player below visit http://Strokecast.com/MSN/vaccine to listen to the whole conversation. Click here for a machine-generated transcript I got my Bivalent COVID-19 booster and my 2022 Flu shot on the same day in October. Who is Dr. Remle Crowe? Dr. Remle Crowe is an expert in EMS research and quality improvement. From truck clutches to clinical care, she has shown how research and improvement science work to solve problems across fields. Prior to earning a PhD in Epidemiology, her EMS career began with the Red Cross in Mexico City as a volunteer EMT. She has authored numerous peer-reviewed publications related to prehospital care and the EMS workforce. Now, as a research scientist with ESO, Dr. Crowe routinely uses EMS data to improve community health and safety. Dr. Crowe previously appeared on the Strokecast in episode 132 to discuss the AHORA pneumonic to help Spanish speakers recognize and respond to a stroke. When it comes to stroke, Time is Brain regardless of which language you speak. A Sampling of the Studies When we claim the data indicates that the vaccine doesn't cause an increase in stroke, what data are we talking about? How did "they" analyze it? Who reviewed the studies to ensure they were accurate? Where can you read the details yourself? As Dr. Crowe explained, there are currently a whole bunch of studies that are coming out. That makes sense; it's roughly 18 months since the vaccines against COVID-19 became widely available. To conduct sound research, you need a large pool of people to look at. You need to take some time to see the results. You need to write up those results. Then you need to submit them for publication. Publications will then need to review before publishing them. That brings us to where we are today with all these studies now becoming available. Let's take a look at a few of them, and I encourage you to click through to the details and read them yourself. Click the study titles for more. Surveillance for Adverse Events After COVID-19 mRNA Vaccination This study published in JAMA (Journal of the American Medical Association) looked at nearly 12 million doses of the mRNA vaccine given to more than 6 million...

A minor electric signal is all it takes to move a couple hundred pounds of human. When we walk, the brain sends a signal through the spine to the individual muscles of the legs, feet, and core to manage the complex orchestra of contraction and relaxation that makes balance and walking possible. After stroke, the brain may stop sending all or some of those signals. That breaks the ability to walk. It happened to me and millions of others. There is nothing wrong with my leg, though. The muscles, joints, tendons and nerves in my leg, foot, and core are all still there and as fully functional as they were before the stroke. They're just waiting for he signal from my brain which, in the beginning, never came. Rehab was about getting the brain to send that signal again. And it started sending some of it. It's not as complete as it used to be. Or as strong. But it's enough that I can walk with my cane and brace well enough, and not quite as well without my aids. But, again, it's a brain issue, not a leg issue. If you can send a signal to those muscles without the brain, can you effectively get those muscles to move and walk more effectively? Yes you can. That's what Neural Sleeve from Cionic does. In this episode, I speak with Cionic CEO and founder Jeremiah Robison about the Neural Sleeve, why it works, how stroke survivors can learn more, and how his daughter inspired this product. If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation. Click here for a machine-generated transcript Who is Jeremiah Robison? Jeremiah Robison is the Founder and CEO of CIONIC, an innovative company that builds lightweight and durable bionic clothing driven by powerful algorithms that adapt in real time to each individual's mobility needs. He started the company in 2018 after his daughter was diagnosed with cerebral palsy and he was frustrated at the lack of effective technology available to help improve her mobility. Four years later, CIONIC introduced the breakthrough, FDA-cleared Cionic Neural Sleeve, the first product to combine sensing, analysis and augmentation into a wearable garment. Prior to CIONIC, Jeremiah spent twenty years at the intersection of data, algorithms, and the human body, driving innovation in sensing and machine learning at Apple, Openwave Systems, Slide, and Jawbone. Jeremiah has a BS and MS in Computer Science from Stanford University. Jeremiah's daughter Jeremiah's daughter, Sofia, was apparently in a rush to meet this amazing world. She was born early, weighing just 2 pounds, 4 ounces. She developed Cerebral Palsy in the process. Cerebral Palsy (CP) and stroke are similar conditions. In fact, as Dr. Heather Fullerton explained in episode 49 ( http://Strokecast.com/PediatricStroke) roughly 50% of CP is caused by stroke in utero or shortly after birth. CP is the result of not enough oxygen getting to the right part of the brain at the right time of development. Brain cells die or don't develop or don't form the right networks the way they should. As a result, a child can develop any number of challenges around mobility, speech, dexterity, and more. Just like adults (and other children) with stroke. The damage from stroke in the brain is also, in part, due to lack of oxygen getting to the right parts when they need it due to a disruption in the blood supply. Stroke survivors have a lot in common with our neuro cousins in the CP and MS communities, to name a few. Jeremiah talks about wanting to help Sofiawith her gait, as any parent would. Jeremiah was in a position to do something about it, and the Neural Sleeve comes from that experience. Sofia herself is now 12 years old and has developed a presence on Instagram with the family's nonprofit at @WAWOSORG. Sofia shares her own inspirational tips and exercise strategies for other kids with CP or other...

Calli Varner and I don't have a lot in common. Calli is athletic and into sports. I … am not. I was born in New York City; Calli was born in the Midwest. Calli thrives in Phoenix, AZ. I still don't understand whatever possessed someone to put the 5th largest city in the US in the middle of an oven. We do have a few things in common, though. We both like cats. We both like to write. And we both experienced stroke at a relatively young age. Sportswriter Calli Varner survived her stroke at 35 Thanksgiving weekend in 2021. I first read Calli's story through the America Heart Association's profile and wanted to learn more. You can read that original profile here. I wanted to hear more so Calli joins me in this episode to share her adventure. If you don't see the audio player below, visit http://Strokecast.com/MSN/Calli to listen to the conversation. Click here for a machine-generated transcript Calli was lucky in her recovery, but luck isn't just about the randomness of fate in the universe. I like the definition that says luck is what happens when preparation meets opportunity. Getting to an ambulance quickly made a difference for Calli. Getting tPA quickly made a difference. Already being athletic made a difference. Determination in her recovery made a difference. Simple, clear goal setting made a difference. And the help of Lt Dan, pushed it over the top. Who is Calli Varner? Calli is a sports lover and writer in Scottsdale. At 35, she never expected to experience a stroke at such a young age. She is active, attending cycling classes three times a week. While visiting her parents over Thanksgiving, Calli suffered from a moderate acute ischemic stroke when a blood clot traveled to her brain. After eight months of recovery that included living with her parents, and going back and forth to doctor's appointments, Calli is now fully recovered and ready to get back to football games. Here is how she was able to become stronger after her stroke thanks to the support around her (especially her cat, Lt. Dan) and keeping her eye on the prize, attending a Chiefs game in the fall. You can follow Calli on Twitter at @CalliDoesSports Calli and Lt Dan Fast Treatment The BEFAST stroke warning signs (Balance, Eyes, Face, Arms, Speech, Time) includes time in the list because it is so essential. Many ischemic (clot-based) strokes can be stopped with a drug called tPA. It has to be administered within the first 3-4.5 hours after stroke symptoms first appear, though. While research is looking to extend that window, today, those limits apply. Every minute of stroke means more dead brain cells. tPA can reduce the damage by restoring the flow of blood, oxygen, and nutrients to starving cells before they die, but can't bring them back once they're dead. Calling an ambulance is the essential first aid step when someone MIGHT be experiencing a stroke. In Calli's case, she got treatment quickly which helped drive her recovery and get her to the life she lives today. Fibromuscular Dysplasia According to the Mayo Clinic, Fibromuscular Dysplasia is a condition that leads to changes in the size of blood vessels, often supplying the brain or kidneys. Narrower blood vessels mean less blood flow to critical parts of the body. These choke points in the circulatory system can also lead to turbulence and turbulence makes clot formation more likely. Calli has this condition in the vessels in her neck and it MAY be what led to her stroke. Ultimately, up to 20% of strokes are "cryptogenic," meaning there is no known cause. It's frustrating because it means survivors don't know how to prevent it. In Calli's case, they speculate that the reason her fibromuscular dysplasia didn't cause issues before was because she was in such great physical shape. Being in great shape doesn't mean you won't have a stroke. It just...

To effectively treat stroke and prevent stroke, you need to know just what is literally happening in a patient's head. CT Scans and MRI scans are tools most of us are familiar with. Generally if you suspect a stroke is possible, you need these two scans done. There's another tool out there, too, that's cheaper, more portable, and involves no radiation. It's called Transcranial Doppler Ultrasound. It's a great complement to the other scans, and it can provide impressive insight to supplement the information from the radiologists. A skilled practitioner is a great complement to the care team. I first talked about this technology in my conversation with Dr. Aaron Stayman a few years back (Is my Brain Pregnant? Ultrasound and Stroke: Transcranial Doppler Ultrasound). It's fascinating stuff. The problem is that it does require a skilled technician or someone specifically trained in the technique. Despite the work of advocates like Dr. Stayman and Dr. Mark Rubin, there just aren't enough of those techs. Dr. Robert Hamilton of NovaSignal has a solution. His robotic machine automates the whole process, makes it faster, more reliable, and cheaper while giving more accurate results in a lot of scenarios. The NovaSignal solution has the potential to make this technology available to patients and medical practitioners around the world. Drs. Rubin and Hamilton join me in this episode to discuss the technology, the research, and the device itself. If you don't see the audio player below, visit http://Strokecast.com/TCD to listen to the conversation. Click here for a machine-generated transcript Who are Drs. Rubin and Hamilton? Dr. Mark N. Rubin is a vascular neurologist and associate professor of neurology with the University of Tennessee Health Science Center Department of Neurology. He specializes in vascular neurology and is experienced in stroke and cerebrovascular disease, and an experienced sonographer and expert interpreter of carotid duplex ultrasound and transcranial Doppler ultrasonography. He received his medical degree from University of Illinois College of Medicine and completed his Adult Neurology residency and fellowships (Neurohospitalist and Vascular Neurology) at the Mayo Clinic. Robert Hamilton, Ph.D. is the Chief Scientific Officer and Co-Founder of NovaSignal. He is an accomplished entrepreneur, engineer, and clinical researcher with a passion for innovative technologies that allow for increased access to care. Robert, a biomedical engineer by training, is an expert in image/signal processing and machine learning, with extensive experience in cerebral blood flow, traumatic brain injury, stroke, and other neurological disorders. Robert co-founded NovaSignal based on technology he developed during his Ph.D. During his tenure at the company, Robert has supported the entire lifecycle of the NovaSignal autonomous ultrasound platform from idea to commercialization with regulatory clearances in the US, Europe, and Canada. Additionally, Robert has designed and completed several clinical trials supporting the use of the technology in different neurological conditions and has acted as principal investigator on federal grants and contracts totaling more than $25M from the Department of Defense, National Institutes of Health, and the National Science Foundation. Finally, Robert has achieved greater than 100 citations of his work in peer-reviewed publications and conferences and holds over 50 patent assets related to the core technology developed during his PhD studies. TCD vs Traditional Ultrasound When most of us think of ultrasound in medicine, we think of the sonograms of developing children, where parents and doctors swear they can see a human being in those black and white lines. Personally, they seem more like those Magic Eye pictures from the 90s. Traditional ultrasound can also capture pictures of the...

Anna Kerry went from yoga fan and enthusiast to Yoga teacher. Then the pandemic hit. A year later, at age 35, she had a stroke due to as PFO. In this episode she shares her story. She tells us how yoga got her through stroke recovery and how it informs her work today. Anna talks about the relationship between trauma and yoga, and she talks about the impact stroke has had on her life with her husband. As Anna has gone through this journey and continued both her studies and her teaching, she developed a yoga program specifically for stroke survivors. And Anna explores the power and near sacredness of her own yoga mat. If you don't see the audio player below, visit http://Strokecast.com/Anna to listen to the conversation. Click here for a machine-generated transcript Who is Anna Kerry? In Anna's own words: I had a stroke aged 35 in March 2021. I've had a regular yoga practice for about 10 years and decided I loved the practice so much that I wanted to learn how to teach and share my love of yoga. I qualified in Aug 2020 and had only been teaching for around 7 months when I had a stroke. As the stroke came out of the blue I had to dig deep into my yoga practice to help me through and believe that my yoga practice has helped my mindset and my mental health during this traumatic time. I'm now in a position where I want to help other stroke survivors through their recovery so I designed The Life After Stroke Programme -- a 6 week programme designed to help stroke survivors regain their life and confidence through a holistic and embodied approach to recovery. What is a PFO? Anna's stroke was caused by a PFO. She found that out a month after her stroke, and she will likely get it fixed eventually. A PFO is a hole in the heart. Roughly 25% of the population has one. I have one. Guests Misha Montana and Christine Lee both had PFOs that led to their strokes. After we are born, our blood follows a path through the heart. It comes in the right side. When the heart beats, the blood on the right side heads out of the heart to the lungs. There, it drops of CO2, picks up oxygen, filters out clots, and heads to the left side of the heart. It will pour into the left side and when the heart beats, it sends that oxygen-rich blood on to the brain and other parts of the body. Then that blood drops off its oxygen, picks up CO2, and heads back to the right side of the heart to start the whole cycle over. Before we are born, though, the process is different. While we are developing in our mothers’ uteruses, we don’t breath air. All the oxygen and nutrients we need to build fingers and toes and kidneys and hearts and brains comes from the umbilical cord. Since we’re not breathing air, there’s no point in sending blood to the lungs. Instead, in utero it goes straight from the right side of the heart to the left side of the heart through a hole in the middle. That hole is called a Patent Foramen Ovale, or a PFO. It normally closes on its own shortly after we are born. A quarter of the time it doesn’t close after birth, and that allows unoxygenated, unfiltered blood to sneak across the heart, skip the lungs and drag a blood clot to the brain. So, if you’ve had a stroke, and you have a PFO, should you have surgery to close that hole? Maybe. Christine and Misha had their PFOs closed. I did not. Anna is waiting to get her PFO closed. I talked about this issue in a lot more detail with Dr. David Thaler. You can listen to that conversation at http://Strokecast.com/pfo. A Place of Her Own Anna Kerry has a special place in this world -- it's her yoga mat. At first glance, it's just a piece of material, but once she is on her mat it becomes a portal to take her to another special place. The mat allows her to center herself. It's a place she can experience joy and agony; happiness and anger; tears and laughter; and...

Jeri Goldstein built an online business coaching musicians who want to book more gigs. After all, success as a musician requires working in the music business. Many aspiring stars are hugely talented with the music side, but not so much the business side. Jeri helps them. Then the phone call came, and Jeri's life changed. It a good thing her business was highly portable Her father survived a massive stroke, so Jeri did what she had to do. She packed up the car and the dog and headed down to Florida to help her family navigate the post stroke world and learn to adapt to her father's aphasia. Jeri chronicled her experience with her dad in her book Stroke Dialogues: Conversations with Dad*. She sent me a copy, and we talked about her experience in this conversation. And she explains what "Dark Moon Shine" is all about. If you don't see the audio player below, visit http://Strokecast.com/MSN/Jeri to listen to the conversation. Click here for a machine-generated transcript Who is Jeri Goldstein? Jeri Goldstein is a career development coach for professional performing artists and entertainment industry professionals. She coaches musicians performing in all genres of music from traditional acoustic to jazz, classical to world music, children’s music to blues and rock and hip-hop to rap. Jeri has also worked with authors, actors, storytellers, visual artists, and other small business owners. Her specialty is to help her clients discover their unique niche market and to create strategic business and marketing plans. For twenty years, she was a booking agent and artist manager for touring artists on the acoustic music circuit. She worked with musicians, actors, and dancers. She is a music and book publisher. In addition to Stroke Dialogues*, Jeri has written two other books. Her award-winning book, How To Be Your Own Booking Agent THE Musician’s & Performing Artists Guide To Successful Touring*, is used by musicians world-wide and has been a textbook used in music business courses throughout the U.S. and Canada. It reached #1 on Amazon in the Music Business category and has sold over 60,000 copies world-wide. The Tiny Guide to Huge Success* is a collection of 100 blog posts taken from thirteen years of over 650 entries designed to help performing artists build and maintain a successful touring career. Jeri presents in-person seminars and keynote lectures at universities, conferences and for businesses and organizations in the music and entertainment industries. Her online course Booking & Touring Success Strategies & Secrets has been taken by hundreds of professional touring artists. In 2020 she launched her first podcast, Get Great Gigs which featured interviews with artists and other entertainment industry professionals that discussed inspiring career strategies before and during the COVID-19 pandemic. Jeri began her internet-based business in 2008. Her use of internet marketing strategies and social media provided the perfect platform for her to work from anywhere. In November 2012, she set up shop in Florida to be with her dad during his recovery from a stroke. After selling her home in Charlottesville, VA, she relocated to Delray Beach, FL permanently in August 2015 and continues to live there today. Homunculus The homunculus is a representation of the brain and various parts of the body. The more you use a part of the body, the more neurons it takes up in the brain. For example, the hands and tongue take up more space in the than the elbow and pinkie toe. The more time and energy you dedicate to something, the more space in your brain is dedicated to that task. For example, a homunculus of my brain would likely show a much larger segment dedicated to speaking than to throwing a baseball. One way I think about how this applies to survivors (and I may be stretching the homunculus analogy) is that a skill from the...

Depression sucks, and it lies. It's a life threatening condition that affects a lot of stroke survivors and can block their recoveries. In 2010, business owner Keith Taylor survived a stroke. A rare genetic condition meant that the arteries and veins in his body don't always connect the way they're supposed. It's called Hereditary hemorrhagic telangiectasia (HHT). One day, that flawed connection leaked and began killing brain cell. Keith began his journey through the stroke care system of the time, into the depths of depression, leaving the business he planned his life around and to the life he lives today helping stroke survivors in Central Oregon and around the world live their best lives. He shares his journey in today's episode. If you don't see the audio player below, visit http://Strokecast.com/MSN/Keith Click here for a machine-generated transcript Who is Keith Taylor? Keith Taylor runs Strength After Stroke Keith Taylor is a deeply passionate, and dedicated leader in the stroke community. He is dedicated to helping stroke survivors regain their own power and strength to live a full and productive life. While owning and being the sales manager of a large manufacturing business in Oregon, he had a stroke at the age of 48. After looking for, and not finding, anyone to help with the depression and lack of confidence after his stroke, he decided to create that for other stroke survivors. He is President of the Board of Directors with Stroke Awareness Oregon and is the owner of Strength after Stroke; a company dedicated to providing resources for stroke survivors to re-ignite their desires and regain their confidence. What is HHT? HHT stands for Hereditary hemorrhagic telangiectasia. That tells most of us…absolutely nothing. The condition impacts the way the blood vessels in our body connect. When the circulatory system works properly, blood flows from the heart under high pressure through the arteries to deliver oxygen and nutrients to the organs throughout the body. One big artery (the aorta) comes off the heart and splits into smaller and smaller arteries that carry blood to the kidneys, the toes, the brain, and every other part. The arteries are built to withstand the blood pressure. Veins take blood from the organs and bring it back to the heart. Along the way, the deliver carbon dioxide to the lungs and waste material to the kidneys, liver, and other disposal sites. The blood is no longer under such high pressure at this point. In between, there are capillaries. These are the tiny, thin blood vessels that allow oxygen and nutrients to pass from the blood to the organs and for carbon dioxide to pass back. Arteries branch smaller and smaller and thinner and thinner to become this huge network of capillaries, which the consolidate and get bigger and bigger until they become veins. Meanwhile, that branching down and consolidating up reduces the pressure on the blood in the system In a patient with HHT, those capillaries don't always form where they are supposed to. Instead, the arteries will connect directly to the veins. These malformations are weak spots since the veins may not be able to handle the pressure of the blood coming into them. These AVMs, or arterial-venous malformations can then rupture or leak resulting in a hemorrhagic stroke. You can learn more about HHT at the CDC's website here: https://www.cdc.gov/ncbddd/hht/index.html#:~:text=HHT%20is%20a%20disorder%20in,present%20between%20arteries%20and%20veins. HHT is not the only cause of AVMs but it is an important one. Nosebleeds Nosebleeds are an important signal that something may be wrong. Frequent or regular nosebleeds are something to discuss with your doctor. Nosebleeds are a common indicator of HHT. Someone who has HHT will need to keep on top of their monitoring to reduce the chances of a dangerous stroke or other conditions....

Julie Kuch had her first stroke in 2009 when she was 30. No one believed her at the time, and she had to convince a neurologist to order an MRI before the medical system began to take her seriously. And once they did take her seriously, the system still didn't offer Julie rehab or even education about how to live life as a stroke survivor. Several years later, Julie had a do-over -- her second stroke. Oh, and she through in a TBI in between. Between her strokes, Julie created the services she wished she had for her own stroke. She became a life coach for brain injury survivors. To learn just what a life coach does, how their services help, and how Julie built this life, listen to this episode. If you don't see the audio player below, visit http://Strokecast.com/Julie to listen to the conversation. Click here for a machine-generated transcript Who is Julie Kuch? Julie is a concussion and stroke survivor. She is a Life Coach for people who have had a brain injury. She has helped 100’s of people find joy and purpose in life again. Julie has survived to strokes and a TBI. Her second stroke was in January 2022. She is currently recovering (very well) from this, her third brain injury. The experience has Julie feeling more passionate than ever that part of her mission in this life is to help as many people as possible recover and feel better than before their brain injury. Julie is grateful for her brain injuries and the valuable lessons they have given her. Julie wants everyone that has experienced a TBI to feel the same, and she know they can. Julie says, "So much of the suffering we go through recovering from brain injuries is not necessary. I teach my clients how to transform from feeling resentful, frustrated, angry, shameful and depressed about the state of their life to feeling accepting, loving, and at peace about themselves and their capacity after a brain injury." Julie certified as a Life Coach through The Life Coach School. A Go Getter Gets Depression Depression is a topic we don't talk about often enough. It's a common stroke deficit, like hemiparesis and aphasia. It interferes with recovery and exercise routines. And it’s not just feeling sad or mourning the end of your previous life. It's a genuine problem that burns energy and can make it even harder to get out of bed and do PT. Or do the basics of taking care of ourselves. Last year, I talked with Dr. Laura Stein from Mount Sanai in New York. She talked about new research showing that stroke itself causes major depression, and not just the impacts of stroke. In 2009, no one told Julie she might encounter depression. We also had less overall public awareness about depression. And when it did hit Julie, she was not prepared to deal with it. She had to deal with her own limiting beliefs about antidepressant medication and about people with depression. Julie talks about the shame and embarrassment she had around her treatment. By 2022, she was better prepared to deal with it. Depression, like stroke, can happen to anyone. It can be a deadly condition. And like any other stroke deficit, it's nothing to be ashamed of. We can know that, but that doesn't guarantee we'll believe that. Why drive during a stroke? Julie had her stroke while she was driving to the doctor's office. But she didn't pull over and call an ambulance. Jo Ann Glim had her stroke in a deli while trying to fix an office sandwich crisis. Misha Montana drove back to Reno while having a stroke. James Horton drove home while having a stroke, Driving while experiencing a stroke is a terrible idea. It's dangerous. It's difficult. The problem is that we rely on our brains to evaluate every situation of every minute of every day. In a stroke, though, the brain is under attack. Millions of brain cells are dying every minute. Various parts are...

What is stress and how does it impact stroke recovery? In this episode, I talk with Speech Language Pathologist, Wellness coach, and endocrinology expert Michelle rusk about the nature of stress and the role of Cortisol in our bodies. Modern life is stressful enough without contending with stroke and recovery. Add more mundane and major sources of stress to our lives on a daily basis drives out bodies to a continuous state of Fight, Flight, or Freeze. Overtime, that causes more health problems, which introduces more stress to the system Breaking the cycle of stress requires that we understand more about it and just how it impacts our bodies. If you don't see the audio player below, visit http://Strokecast.com/Stress to listen to the conversation Click here for a machine-generated transcript Who is Michelle Rusk? Michelle Rusk is a North Carolina based Speech Language Pathologist, licensed to treat patients in North Carolina and Virginia. She is also a Wellness Coach and Dutch Test practitioner working with clients from all over. She owns and operates Coastal Speech Therapy and Wellness. Coastal Speech Therapy & Wellness is a private practice offering virtual therapy throughout Virginia and North Carolina for those with brain injury. She serves patients as a therapist, certified brain and hormone health coach, and DUTCH test practitioner. What is Cortisol? Cortisol is one of the body's stress hormones. When an emergency arises, the body dumps cortisol into the system to increase blood pressure, blood sugar, and other mechanisms that give us extra resources to run away or fight a threat. Humans have been around for about 100,000 years. Up until the last hundred years or so, that system worked fine. Modern life though, for all the wonderful and amazing things it offers, introduces a lot of low level stress that builds and builds. In response, our bodies push more cortisol into the system. We end up living with a higher level of cortisol than we were ever meant to. That contributes to a whole array of health issues. As Michelle explains, the way to address that is with lifestyle changes, What is the Dutch test? Michelle uses the Dutch test with her wellness patients. It's a urine test that assesses the levels of hormones in a person's system, with cortisol being the big one. The company actually offers a variety of tests that work in different ways to assess hormone levels. You collect the samples at home, send them off to the lab, and then get the detailed results. You can learn a lot more about the tests and see sample reports at http://DutchTest.com. Once you get results, you should discuss them with your doctor or medical team. Actually, it's probably a good idea to talk with your medical team first because these tests can cost several hundred dollars and generally won't be covered by health insurance. Social Wellness Groups Michelle's comments on social wellness groups are also interesting. An online or in person stroke support group is a powerful thing. There's a lot of value in connecting with other survivors. It's not just about getting tips for living with stroke or learning about local resources, though. It's about the community. Often we can go through our days isolated. Most of the people we talk to have not experienced a stroke. They can't understand our experience. In a support group, though, we're around people who do "get it." And that's a big deal. A social wellness group takes that to another level. There are the benefits of the community, sure, but there's the added benefit of the instructor led skill development. Michelle is able to coach conversational norms, among other things, to help reduce the sense of isolation out in the real world. Michelle on Discharge Day Michelle mentioned how amazing discharge day is, even if it is tinged with sadness...

Often we tend to think of "patients" and "providers." While sometime we may accuse medical teams of forgetting that their patients are whole human beings and not just a wrist band and chart in a hospital bed, it works the other way, too. We sometimes forget that our doctors are more than white coats adjusting out medications and asking who the president is -- again. But doctors are, in fact, human. And they can create art. And they can have strokes. Dr. Bevan Choate, MD, was a surgeon and urologist just enter the heart (or kidney) of his career. One morning, everything changed. He shares his story of the past 18 month in this episode. (If you don't see the audio player below, visit http://Strokecast.com/Bevan to listen.) Click here for a machine-generated transcript Who is Dr. Bevan Choate, MD? Bevan was bornin 1985 in San Angelo, TX. What do you do when you are born in San Angelo, TX? You grow up on a horse. As Bevan says: "I grew up in a cattle ranching family. Cowboying since I could ride a horse but perhaps due to the Waylon and Willie song, they didn’t want me to grow up to be a cowboy. So, I was given all the odd and less glamorous jobs. https://www.youtube.com/watch?v=RePtDvh4Yq4&ab_channel=kdn3249 I realized about midway through undergrad that I wanted to be a doctor. I was always a science geek at heart, and figured medicine to be a pure and noble application of science. I excelled in medical school and completed my five-year Urology residency in Albuquerque at the University of New Mexico Hospital. It was the roughest five years of my entire life. Being a sleepless subordinate for almost two thousand days is a tough pill to swallow. Nonetheless, I persevered and began practicing Urology in Albuquerque. It was my calling. I love it. I love my patients and some of them even love me. I did quite a bit of oncologic surgery and got good at robotic surgery using the Da Vinci robot. " Things changed for Bevan on December 3, 2020. That's when a left vertebral artery dissection threw a clot that lodged in the left part of his cerebellar and proceeded to kill millions of valuable brain cells. The dissection has no "attributable etiology." That's how doctors write a shoulder shrug emoji. No one knows why it happened. Bevan just got lucky. The surgeons who were not Bevan got to work. His procedures included a ventricular shunt, a craniectomy, and a left cerebellar strokectomy (surgical excision of infarcted brain tissue post-stroke with preservation of skull integrity, distinguishing it from decompressive hemicraniectomy). As Bevan says, "Yep, I have about 80-85% of a brain. Not playing with a full deck" Following this adventure, Bevan contended with: Since then, he's accomplished some impressive things, not the least of which are living and walking. He's also become a published author and a professional artist. He's also still practicing medicine and seeing patients. The laser may need to wait a little while though. It's been quite the year and a half. Typing around a Stroke People approach their stroke recovery in different ways. Bevan and Michael Schutt both launched their writing projects to learn to type with their affected side again. My approach to typing was the opposite. Instead of forcing my left hand to the keyboard, I wanted to get faster more quickly. I taught myself to type more quickly with one hand. I'm currently at about 34 wpm (average for two-handed typists is about 44 wpm). Has that slowed my recovery? Maybe. Recovery is a delicate balance of accepting a disability and fighting that disability. Too far in one direction is not great for living the best life possible for many folks. Of course, every stroke is different. I can admire the approach others took without feeling mine was wrong. Especially since my fingers are still (slowly) coming back. And if...