Your brain’s response to injury

When your brain is injured by stroke, it mounts a significant response to repair the damage and clean up the mess. The result is similar to what happens anywhere when you injure yourself. White blood cells are activated to absorb dead and dying cell debris and carry it away in the bloodstream. Some brain cells form a kind of scar tissue on the edges of the injury. When the stroke is larger than a few cells, a small cavity, which fills with a clear or yellow fluid, forms in the brain. When a red stroke heals, it often stains the brain yellow because the white cells change the color of the red pigment of blood in the process of cleaning up the blood clot. This is similar to the yellow tinge that you may have seen as a bruise heals.

Evidence indicates that part of the healing process for the brain may include some sort of rewiring. The younger you are, the more extensive the rewiring is, and the more rapidly it occurs. What actually happens in the cells is something of a mystery. Whether new cells are formed as part of the process remains unclear, but we do know that new connections are formed.

One of the best-studied examples of rewiring is when patients with normal vision become blind. When their brains are studied several years later, it is clear that the part of the brain that used to respond to visual stimuli now responds to touch in the fingers as the patients read Braille.

TPA: Clot-buster to the rescue.

One Saturday morning, a 75-year-old man was in his yard when he developed a headache, right-side weakness, and confusion. Neighbors called EMS. He was brought to the emergency department of a mid-sized Midwestern hospital.

When first examined, he couldn't lift his right arm, the right side of his face drooped, and his right leg was weak. He was unable to talk and did not seem to understand what was being said to him.

He was taken for a CT scan immediately. No blood was seen on the CT. Because of his symptoms, the doctor taking care of him thought that the problem was probably in the left internal carotid artery or one of its main branches. Because there was no bleeding seen on the CT scan to suggest a red stroke, the doctor assumed this was a white ischemic stroke caused by a blood clot blocking an artery.

The doctor on call gave TPA, tissue plasminogen activator, a commonly used clot-buster for stroke patients, to dissolve the blood clot two hours after the stroke started. The patient had recovered the use of his right leg and could speak and understand words to some extent.

This man owes a lot to his quick-thinking neighbors who got him to an emergency room so fast. After a stroke, brain function generally improves some with time. This is true regardless of the type of stroke. The improvement is more rapid in the first few weeks and months and is thought to be greater if other problems, such as muscle contractures and atrophy of muscles, are prevented. Occupational, speech, and physical therapy all incorporate exercises to aid in rehabilitation. Recent research indicates that such therapy may play an important role in stimulating brain rewiring and regrowth. Naturally, the larger the brain injury is, the less you will be able to recover.

How the brain manages all the different senses

The picture that you see as your brain peers through your eyes and out into the world travels to the visual cortex in the very back of the brain. The scene each eye picks up goes to the brain stem, to a little junction box. Nerve fibers from the junction box send this data across the middle of the brain stem and to the very back of the brain where it’s projected on the opposite side. For example, what your eyes see to the upper left is shown on the lower right part of the map.

Hearing is presented on a whole series of little maps that arrange the pitch by frequency. The hearing cortex is located between the more straightforward mechanical areas that coordinate movement and the areas where more emotional functions are known to reside.

Ordinary touch is mapped according to the position on the body, just like the area responsible for simple movements. Taste and smell have their own special locations in the brain stem and frontal cortex just above the nose.

Taking steps to prevent stroke

Fact is, neither you nor I nor your doctor knows for certain whether a stroke is in your future. It’s not really possible to predict with any certainty exactly who will suffer a stroke. To some extent, having a stroke is a matter of bad luck. But we do know that certain characteristics place you at a greater risk for stroke. We know that you are more prone to this particular form of bad luck if you have high blood pressure, smoke cigarettes, and/or have heart disease, diabetes, or high blood cholesterol levels. Researchers have identified a number of indicators that can help predict the likelihood of stroke. Some you can influence; others you can’t.

Will

Molested

Abused

Mauled

Stepped on profusely

Stopped

Barred

Prevented

For living fully

Rejected

Maligned

Gagged

From the freedom that I enjoy

Busted

Wrecked

Wasted I now employ

Cursed

Sworn to

By the things I used to do

Belittled

Antagonized

All gone even the few

Raped

Burnt

Left nothing with me

Saddened

Strayed

Death now I see

Darkness

Emptiness

Creeping at me

Feared

Trembled

Roar of a strange voice

Telling

Whispering

I have to make a choice

It’s going to take a while

Or I guess eternity

To realize

Better get ready

For what might

Turn to vice

Stayed away from

Ignored

But I won’t adhere

This broken

Twisted

Perception of fear

Though rejected

Misused

Stand up will I

Unable

Disabled

And cease to when I die

Dilemma II - ''First time''

This is quite an unusual task for me of ever having to describe myself to someone or to a group of people in writing, such task which I have done on most of my first days in school way back then (although some of it were recited to my new teacher and classmates).  To me, it is my first time of my first time, and during my first time…

Before I get to quantify and lay to you how I was able to come up with these “first times” of mine, I will first introduce myself in a simple and comprehensive manner I know, that is the friendly and pleasant way.

I am a graduate of Bachelor of Arts in Philosophy and Letters at one of the colleges around university belt in the Philippines.  Sad to say, and now I came to realize that I took the wrong course because all it gave me were thick volumes of books with no illustration on its pages, endless debates over something that can be settled through simple “paper, scissors and stones”, and the art of having to argue by maneuvering and finding my way out through the loopholes and weaknesses which my proponent possesses.  So deeply engrossed with the skill, I took it in defending myself amongst the older members of my family.  It was always my parents who became my “practice dummies” since they were the one who were always at “the other side”.  I was later more engrossed with my skill that I took it and converted the same into actions.  Considering my young age, it somewhat made me more aggressive and more selfish.  And these actuations had landed me on the forefront of the most precious, extravagant and unimaginable job a young and idealistic youth should ever have:  being a father.  My mom always told me to always be optimistic on everything so I can safely say, without disrespecting her that, I got married and had my child as early as less than a year after I graduated from college.

I had always longed for a challenging life.  That life which battles my instinct and my ego so I guess God was all ears on me when I wished that thing and He was too generous that time that He gave me one, which I consider to be one of my “first times”.

the 'wheelchaired man'

Having a family at an early age was definitely an odd event in my life, though the same taught me well to be responsible, more caring and more understanding.  And while most of what I’ve learned is already been innate, I still craved to the beauty and temptations of the “dark side”.  Because of my early exposure to “life”, I saw the offerings and the benefits I could gain.  I was eager to undergo all the “first times” in my life.  From socializing and interacting to almost all kinds of people, I learned how talk effectively with them, I gained their ways and absorbed almost everything that this world had to offer.  In short, I became a selfish monster who knew nothing else greater than me.  Few years had passed since I went into the “dark side” and have learned to embrace it without having to forget my morals and spirit of goodness; that the “switch” I did finally took its toll on my selfish soul.  

At exactly six o’ clock in the evening last June 6, 2008, I experienced another “first time”.  I suffered a hemorrhagic stroke. Test results said that some of the arteries in my brain got busted up brought about by an 8cc blood clot on one of my brain arteries.  I was, and, is currently, paralyzed.  The left part of my body – arms and legs cannot feel a thing.  After a week, my “first times” in life all happened.  I painstakingly underwent Physical Therapy every other day, and have been doing the same exercises that I learned since the “stroke” stroke.  Now, every single day in my life is more of a struggle than a challenge, that which I dreamt of having. Every “first time” is a true victory for me, and that includes my own personal victory of having to do and learn almost all the skills of a normal person.  From my first move in transferring myself from my bed to my wheelchair, my first time to stand without any assistance, my first step, my first trip to the bathroom, etc.  I once again enjoyed and savored every victory and milestone that I made while recovering from this fatal illness.

I am now submitting myself to the test.  This is the test which every man must face in the course of their lives.  It is the test when you face yourself and there is no one that can help you nor conquer your fears and admonitions of failure but yourself.  And I know that facing these challenges and struggles with a heart will make me a triumphant “first timer” in the end. 

 

Home care

This is a portion worth reading for those concerned:

“Two-thirds of people who have had a stroke will need some type of support at home over a period of time. This could be practical support such as help with washing or dressing or psychological support such as motivational techniques, anxiety management. Much of the support will not be provided by health care professionals but will be provided by a mixture of family, carers, charities, local authorities and dedicated organizations.

For practical help such as getting up in the morning, assisting with meal times, and helping with getting dressed, most patients will be assessed by statutory services such as social care and will be recommended for what was known as ‘home care’. Long-term psychological support for both the patient and the carer is sometimes harder to secure and this is often what people will ask for when the routine rehabilitation has ceased.” (Occupational Therapy and Stroke Second Edition Edited by Judi Edmans.)

Wheelchairs

The provision of a wheelchair for a patient following a stroke can be considered for two main reasons – for correct positioning during early management and for indoor/outdoor mobility during the rehabilitation stage.

“The type of wheelchair appropriate for a stroke patient could include attendant propelled manual wheelchairs and indoor- or outdoor-powered wheelchairs.

Attendant-propelled manual wheelchairs can be used to achieve better positioning and to improve sitting balance on the ward, which is not always possible with armchairs or high seat chairs. A pressure care cushion should always be provided with the wheelchair and monitored throughout the day by nursing staff and therapists. Access to attendant-propelled wheelchairs adjusted for specific patients can also enable patients to be taken off the ward by their visitors for often much-needed stimulation. Ideally, a wheelchair should also be available for the patient to use for outdoor and/or indoor mobility on weekend leaves and on discharge. In some settings patients are discouraged from trying

to propel themselves with their feet, and self-propelling manual wheelchairs are often avoided altogether. It is thought that the patient’s muscle tone will increase when using the unaffected arm and leg in this way. It is best to discuss the approach.

Indoor-powered wheelchairs could be considered for patients with severe physical disability and those with chronic heart and lung conditions. A patient’s cognition and visual perception should be fully assessed as part of the wheelchair assessment. The use of a powered wheelchair in hospital can help increase motivation and might be considered as an intervention option for spatial awareness problems and inattention.

A combined indoor/outdoor- and outdoor-powered wheelchair would require a full assessment by the hospital-based occupational therapist and specialised wheelchair therapist, carefully taking into consideration the patient’s vision, perception and cognition.

These wheelchairs can be issued to patients with severe, long-term mobility problems. When assessing any type of wheelchair on a long-term basis, the home environment and local area in which the patient will be living should always be taken into account. The access to the patient’s home, the type of accommodation, the width of all internal/external doorways, the layout of the furniture and other fixtures/fittings, the door thresholds and the floor coverings should be considered for suitability of a wheelchair.”  (Occupational Therapy and Stroke Second Edition Edited by Judi Edmans.)

4Ws

Waking up this morning in spite the luring cold weather, I was forced to write about the things I should be thankful of. God blessed me with life and 4 W’s. The will, want, wisdom and the wheel chair.

The first two are almost the same but not to someone like me. I can want but the manifestation is nothing if I lack the will. And what can will possibly do alone if not wanting?

Wisdom makes me alive. Mediocre type it may be, it keeps me conscious and sane at times. The right amount of wisdom keeps me in touch with everybody and pushes the right keys in me in order to keep me grounded on earth as well as with myself.

The wheelchair is considered as my foot that helps me go through the demanding tasks of a stroked life. My friend and my partner. I draw strength just looking at it. An added inspiration to those small things that I should be thankful for.

power of sleep

‘’Following stroke, patients may be faced with occupational dysfunction. Occupational performance capacity may become impaired, impacting on their physical, cognitive and psychosocial capacity to adapt to effectively meet the demands of and engage in their usual occupations, thus impinging on their occupational identity, health and well-being.’’ (Occupational Therapy and Stroke, Second Edition, Edited by Judi Edmans).

To hear or simply read such lines from the expert simplifies a thing. Whatever way one puts it. It spells restraint. Because of the incapacitation on everything, tears came running down my cheeks again. It went down together with my hopes and dreams. Depressed and felt fallen apart, I resorted to my last known solution to these; although temporary, it felt good, I slept.

It does not solve anything but waking up gave me a new perspective on how to face this dilemma.

How I wish it was all a dream

Those things may not be as it seems

New life and hope I guess

Nothing but me in a dress

Though wrecked, everything new

All turned alternately black and blue

Left me with sanity and needed wisdom

To lift myself and carry all along

Telling me please don’t bother

Asking or look in another

Or tell me what it is all about

All I can say is: I’m down, but definitely not out!

Troubled goals

Being a person with stroke is extremely hard. No road or method is easy. You are hurting both from the inside and out. At times your mind dictates while your body does not feel like going through your mind, or it’s the other way around at certain times. The feeling of being limited seeps in and desperation pulls you back suddenly. Then hope slowly fades. Goals seem like mere utterances. The fire in you dies down. Pale, weak, uninvolved persona emerges. The masked depression attacks again strategically.

But just as being true and honest about the matter, everything and anything all comes down on how you treat it yourself. By surrounding yourself with people with concern can help you. Deeply focusing on what is to be done instead being distracted by negative thoughts also works well.

Take time. Time to transcend and empathize. Depression is a real mean mental enemy that could worsen your status if not handled correctly.

Homework

I am forced to show these raw videos of me in my early stroke home rehabilitation process.  Taken 3 years ago, I am now more strong and stable. My full determination and will made me stand upon all setbacks and hurdles in life.

Nightmare

Compared to what I am right now is way far out different. The sudden change in my physical appearance was dreadful in a way. Before, I play basketball, do fairly in table tennis, doing well in swimming, and do know how to play various musical instruments such the guitar, keyboards and the drums.  It is quite alarming that someone who’s active as me suffer stroke.

Well aside from those, there’s another side of the coin that triggered the stroke. This are not forms of arrogance but I stupidly did these. I consume 3 packs of not lights but red cigarettes a day. The number of packs increases each time there’s a ‘drinking session’. I don’t know but I seem to run out of alcohol that I tend to crave for more. These sessions of mine runs almost every day. So hooked that it doesn’t matter what are we drinking – beer, brandy, whiskey or vodka. As long as I am soaked with the spirit, I don’t care.

The worship and love for food is another matter. To some, ‘’eat’’, but to me, ‘’devour’’. What are 4 extra rice every meal? I don’t mind the dangers of fatty foods, unwanted excessive calories and carbohydrates as long as I'm full and satisfied.

Now, it’s everything but a finished phase in my life that never would I try one more time. It was really a hard earned lesson in life. 

Hurdle

Try to empathize with me for a moment. Witness with me the scale of pain I underwent before facing you.

Because of the stroke, I was bedridden for 2 years. It seems that the only thing I could do then was sleep. During that time, I was medically sedated. I eat thru an NGT – a hose that is as small as a soda straw, and runs from my nose all the way to my throat. Everything I eat had to blended well. I never felt hungry or full as stopping that ordeal of eating food through the nose was always a priority.

Bone spasticity made it worst. I can’t even raise or move limb. There’s always someone helping me who would turn my body in bed to avoid bed sores. But this resulted to absurdity as I eventually got sores. To make me sit without any guides whatsoever for 10 minutes is hell for me.

2 yrs. ago with my sister and my therapists

Getting up from stroke, on the psychological aspect is the most bitter of it all. The opening of my mind and acceptance of reality should and must be made abruptly. I was able to overcome it with the love and care from God, from the people close to me and to my heart, and to you who’s now reading this blog.

Yesu

I’ve been to quite a few battles in life. I couldn’t say that most of them are triumphant. Where in the world I gain such arrogance to shout out loud that I won it all considering my present state? I’m likened to a child who lost his candy. I lost almost everything. At this age, I lost my father, my wife, my children, my health, my job, my hopes and dreams. It also came to a point where I also nearly lost my sanity. How I wish never to open my eyes again as I sleep at night. My pillow, blanket and the anguish are my only comrades each time I feel like crying.

It was through this obnoxious event that I suddenly noticed the Chinese characters tattooed in my left arm that means ‘’Jesus’’. I then realized that I need not be afraid though everything was lost. I've got Jesus beside me, looking over my shoulder. I still got Jesus.

Yesu

Adherence

Accepting the reality was objectionable on my part. Being able to succumb to the instances, swallowing the pride and appreciating what was left parted at me unguardedly. It was a big deal for me not being able to do what I used to. My movements were limited as they are bothered by muscle spasticity.  Numbness coupled with pain is what’s best to describe it. Lifting and stretching a leg felt like lifting a heavy boulder. I am now married to my wheelchair and my canes. What I am right now is also caused by the motivation and care of people who pushed me harder and helped me realize that there is hope. All I have to do is formulate a frame of mind that this stroke is just a wake-up call in my current wrongdoings in life.  I gradually learned to accept and appreciate the minute things in life. Looking for my purpose is the next thing, but I know it will come eventually.     

change...

Having known that lifestyle dramatically matters much on people having a stroke, there can be no possible way but consider changing it. I know that it’s easier said than done. Some may take it lightly, some would ignore it. Giving it a try can absolutely garner you healthy prizes in return. It’s true that we can never learn enough on one thing unless we, ourselves experience it. But it is entirely different in this case. We don’t want to be caught in a place where ‘’it’s too late’’. Hard it is but worthy in the end.

The risk of stroke can be reduced through lifestyle changes:

• stop smoking

• control blood pressure

• get regular exercise

• keep body weight down

• avoid excessive alcohol consumption

• get regular checkups and follow the doctor’s advice regarding diet and medicines

Changing the same gets you more focused and develops a more optimistic view in life. Longevity in life prolongs. 

Risks

As said by medical experts and concerned individuals, that prevention is the best answer to all worries and illnesses. But what are the specific risks factors concerning that fearful and apostate stroke? Knowing them could save us a fortune, precious time, our lives and those of our loved-ones. Studies have revealed the following as contributing risk factors:

smoking

• Age & Sex – stroke tends to attack on older people. Those aged 55 or above are more prone to stroke although recent studies show terrifying conclusion that the age bracket widens, meaning anyone as early as 20 can be a candidate for stroke. Men are more likely to have a stroke than women. It’s maybe caused by- you guessed it right,
• Lifestyle choices – those who are more stressed, uncontrollable consumption of alcohol, food (obesity) or drugs (cocaine and other intravenous kind) and smoking.
• Diseases – those who have diabetes, high blood pressure and other heart ailments has a greater risk of having a stroke.
• Heredity – well its maybe true that it really ‘runs in the blood’, a family history of stroke and heart problems targets a high possibility of having one. Studies show that Hispanics, Blacks and Asians have higher rates of having a stroke because related partly of them having high blood pressures than white people.

There are risks that are unavoidable and there are those that we can. It’s never too late to get a hold and control of these risks.

Facts

While I was waiting to go back to my usual self, I managed to learn deeply various elements of what I’m presently engaged at and currently suffers from. Through some research on the internet and medical books, I have found out that stroke statistics would present that,

• more than half a million people in the United States experience a new or recurrent stroke each year;

• stroke is the third leading cause of death in the United States and the leading cause of disability;

• stroke kills about 150,000 Americans each year, or almost one out of three stroke victims;

• three million Americans are currently permanently disabled from stroke;

• in the United States, stroke costs about $30 billion per year in direct costs and loss of productivity;

• two-thirds of strokes occur in people over age 65;

• strokes affect men more often than women, although women are more likely to die from a stroke; and,

• strokes affect blacks more often than whites, and are more likely to be fatal among blacks.

I have also noted that this fatal illness is most likely to strike to Asians. Moreover, it is stated that a stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke is also sometimes called a brain attack.

Amongst are the clearer views of what are the types:

“There are four main types of stroke. Cerebral thrombosis and cerebral embolism are caused by blood clots that block an artery supplying the brain, either in the brain itself or in the neck. These account for 70–80% of all strokes. Subarachnoid hemorrhage and intracerebral hemorrhage occur when a blood vessel bursts around or in the brain. Cerebral thrombosis occurs when a blood clot, or thrombus, forms within the brain itself, blocking the flowof blood through the affected vessel. Clots most often form due to “hardening” (atherosclerosis) of brain arteries. Cerebral thrombosis occurs most often at night or early in the morning. Cerebral thrombosis is often preceded by a transient ischemic attack, or TIA, sometimes called a “mini-stroke.” In a TIA, blood flow is temporarily interrupted, causing short-lived stroke-like symptoms. Recognizing the occurrence of a TIA, and seeking immediate treatment, is an important step in stroke prevention. Cerebral embolism occurs when a blood clot from elsewhere in the circulatory system breaks free. If it becomes lodged in an artery supplying the brain, either in the brain or in the neck, it can cause a stroke. The most common cause of cerebral embolism is atrial fibrillation, a disorder of the heart beat. In atrial fibrillation, the upper chambers (atria) of the heart beat weakly and rapidly, instead of slowly and steadily. Blood within the atria is not completely emptied. This stagnant blood may form clots within the atria, which can then break off and enter the circulation. Atrial fibrillation is a factor in about 15% of all strokes. The risk of a stroke from atrial fibrillation can be dramatically reduced with daily use of anticoagulant medication.” (GALE ENCYCLOPEDIA OF MEDICINE 2,-Stroke)

intracerebral hemorrhage 

And below classifies my stroke:

“Hemorrhage, or bleeding, occurs when a blood vessel breaks, either from trauma or excess internal pressure. The vessels most likely to break are those with pre-existing defects such as an aneurysm. An aneurysm is a “pouching out” of a blood vessel caused by a weak arterial wall. Brain aneurysms are surprisingly common.

x x x

Intracerebral hemorrhage affects vessels within the brain itself, while subarachnoid hemorrhage affects arteries at the brain’s surface, just below the protective arachnoid membrane. Intracerebral hemorrhages represent about 10% of all strokes, while subarachnoid haemorrhages account for about 7%.” (Ibid)