Taking all the medical mumbo-jumbo out of the picture, the shoulder joint, a ball and socket formation, is the most flexible of any joint in the body. It also makes the shoulder the most unstable joint. In a subluxed shoulder, popular wisdom, in plain English, explains that the shoulder joint’s failure of the socket to completely cover the ball of the upper arm bone makes the shoulder reliant on soft tissue instead to hold it in position. When the upper arm comes substantially out of the shoulder socket, it allows for less mobility, and subluxation results.

With a shoulder subluxing, the patients sometimes feel a popping sound as the ball joint moves out of the socket then returns. Some patients feel their arms losing feeling. Others get a sense if they raise their shoulders too high, the shoulder will pop out permanently which, of course, it sometimes does. When shoulder subluxes, pain occurs and is positioned primarily in the shoulder joint. The American Academy of Orthopaedic Surgeons (AAOS) says most of shoulder subluxations happen because the shoulder slips forward, starting the patient’s pattern of avoiding motions which give pain to the patient, thus resulting in weakness for those motions the patient can’t–or won’t–do anymore. The AAOS says the shoulder will often sense numbness and tingling, traveling down the arm.

Visual signs are often these:
* Swelling or bruising over the spot where the injury occurred.
* Less rounding of the subluxed shoulder as compared to a healthy shoulder.
* Dimpling below the bony protrusion at the top of the shoulder.

Even if you can’t interpret the visual signs that accompanies subluxation as needing HELP, there is the pain, and that’s where Robert comes into the picture. This excerpt comes from Robert, and I offer it to you, coming right from the man’s heart:

“The ER …man what a scary place…not much compassion there. They deal with death every day and it shows they do what they can, but honestly, how would you like the job of trying to calm down family members of a patient on the brink of death…that’s gotta be hard on your heart and soul. Sharon was in ER for a week. The doctors told us not to expect her to recover and said if she did recover at all, she would have total loss of her left side. Ok, with that news shocking the family, what was I supposed to do? This is my soul mate and I knew if I gave up, she would, too. There was no way I was going to let that happen. So first things first. I taught her to eat so they wouldn’t put a feeding tube in her (tough fight there they kept ordering a tube and I kept telling them to wait. I knew she would eat on her own given the chance). Ok, now we’re off to recovery center.

In-patient rehab….These people do great things and they’re very positive and encouraging (what a refreshing change). The therapy she received helped her leg, her speech, her eating and swallowing, just about everything but her arm and hand…this is what I would like to talk about.

I have been by her side since her stroke every therapy she got. I repeated it in her hospital room and her recovery was amazing, but they couldn’t really do anything for her arm (mainly due to the pain). I asked them about a sling to hold her arm and shoulder joint in place (they said the pain and swelling was from pinched nerves in the shoulder). They said that she just had to work through the pain because there was no sling that really worked for the sublux shoulder.

My answer to that: bull*&^%.

I watched her therapist hold her arm in place and her pain went away. I started searching for a sling …and sadly they were right. Every sling I found caused more harm than good…and they wouldn’t let me put any on her. (They did try the givemore sling, but it just didn’t work. Every time she bent her arm, her shoulder fell down). Well, I didn’t stop there.

When she got home, she had in-home care and I started making different slings while her therapist kept telling me what was wrong with each sling (I made 10 kinds). Finally, they started liking where I was going with number 11. When I finished it, her therapist loved it. Her pain level dropped to where she no longer takes pain meds. The recovery of her arm jumped 80% in two weeks. Now, all of her doctors and the therapist require her to wear the sling I made.

All of her doctors and therapists kept telling me to patent the sling and get it out to the public because there were so many people out there that needed one. So I applied for a patent and put together a workshop to make them.

Over the years, many people have tried to make an arm support for patients with shoulder problems. For a sling to meet the needs of the patient, it has to conform to criteria considerations such as subluxation reduction, easily worn/put on, ability to wear under clothing comfortably, weight distribution, freedom of movement of both upper and lower parts of the arm while keeping the shoulder in place. Our sling meets all these requirements.

My sling starts with a comfortable arm support. I start with an elastic arm band with non-elastic cloth ends with elastic hook and loop fastening system for arm size and comfort . This is placed over the bicep of each arm. Each arm support has a strap permanently mounted on the top front and one strap grommet and one quick-release buckle mounted to the top rear.

The straps are made of semi-elastic material. The top 2 straps start in front of the shoulder and go over the shoulder, crossing each other in the top middle of the back, and the strap from the top front of each arm support connects to the opposite arm support at a point at the top of the arm pit in the back at the buckle so you can adjust the upward pull on the injured shoulder. The third strap runs across the back from arm pit to arm pit with a hook and loop adjustment for lateral support of the shoulder joint.”

If you, or somebody you know, have a subluxed shoulder, go to this site:

https://sites.google.com/site/subluxationsling/

Scroll down to the bottom and that’s where you can buy the sling.

Even though I had my stroke 3 1/2 years ago, Robert, who communicates through the therapist, says it might help me restore my arm somewhat. My sling arrived today and I’ll report back to you in three months how it’s working out. As I often say, stay tuned!

*Editor’s note: Joyce has been using the sling for over a month now and says she is pain free!

Image of a brain bleed caused by a stroke in a baby.

This is a brain. It is also the unfortunate outcome of a baby whose mother experimented with cocaine, resulting in a premature birth and a bleed in the baby’s brain. A bleed in the brain means the baby had a stroke. Hey! Wait a minute! Babies and strokes don’t go together, or do they?

Note: for all you baby-makers out there, I’m not trying to scare you from having kids. This post is just a dose of reality.

You probably don’t know the name Duncan Guthrie. He started a charity in 1952 for his daughter, Janet, who had polio, and he was determined to find a cure for the disabling disease. With money funded by the charity, research, in time, led to the first oral polio vaccine which wiped out new cases of polio in the UK. Now called Action Medical Research, the charity encompasses so many other afflictions, and that leads us to babies and strokes.

In 2009, Action Medical Research estimated at least one baby out of 2,300 in the UK born full-term were victimized by a stroke. These strokes often were unexpected at the time of birth or before, i.e. some developing babies had strokes in utero. The researchers didn’t know if the babies, who are now barely three years old, had trouble using language because they hadn’t matured to the point where anybody could tell the difference between a three year old saying gibberish or not.

But of the 100 or so children in the study, the researchers are working feverishly to know how stroke affects their language skills. Magnetic Resonance Imaging, most commonly known as MRI, is administered to the child to watch how stroke affects different parts of the brain. Sometimes, the brain readjusts itself, said the researchers, especially in a newborn, to compensate for the section that was harmed. Known by the medical term as plasticity, the brain takes charge of the imperfect tissue with the good part of the brain. In fact, in the first 28 days of life, stroke is more common than after.

So the big question is, how do you know if the newborn had a stroke? Newborns most likely would show no signs of a stroke unless they have a seizure. Seizures symptoms include staring, rhythmic and spasmodic episodes in the face, arms, and legs, stiffening of muscle groups, and pauses in breathing. Generally, newborn stroke survivors show less movement on one side of their body. “Handedness,” the term given when newborns favor one hand over the other, could be a symptom of stroke.  Parents often mistake this as meaning that the baby is advanced for his or her age. In healthy babies, handedness appears at about 12 months.

According to the American Heart Association Journal (AHAJ), the incidence of stroke in newborns in the first 28 days is very elevated compared to infancy and childhood years. The following can happen at a rate of 1 in 4000 newborns:

• Arterial Ischemic Stroke (where blood flow is stopped in an artery to the brain by a clot)
• Sinovenous Thrombosis (where a clot appears in one of the veins in the brain)
• Hemorrhagic Stroke (where an artery bursts in the brain).

After the newborn period, the risk of stroke decreases significantly and remains low until post-55.

This is what can happen in pregnancy and childbirth:

• Proteins travel from mother to fetus, which aids in clotting. But if there’s too much clotting, a stroke for the baby is more likely.
• At the point of labor and delivery, childbirth can result in physical stress on the baby’s head with the arteries and veins in the baby’s head leading to clots and stroke.
• Newborns have twice as many red blood cells as an adult which can lead to excessive clotting. (Stroke can sometimes be prevented by giving newborns an exchange blood transfusion where the blood is diluted with saline).
• Dehydration can cause the blood to clot, some signs of which are a dry mouth, dry skin, and fewer than six wet diapers a day.

A number of factors that can put a newborn at risk for stroke include:

• If the newborn has a hole in the heart, it facilitates a clot going up to the brain.
•  If there is a genetic history of clotting problems, the risk of stroke increases.
• If serious infections such as sepsis exist, clotting may result.
• If the mother takes an illicit drug, like cocaine or heroin, a stroke, albeit needless, may occur.

For expectant mothers, if clotting disorders are part of your genetic history, tests can be done in-utero ahead of time to help the baby’s outcome. All expectant mothers should eat nutritiously, stop cigarette smoking, and avoid dehydration.

Here’s the bottom line: there’s not much research so far on how to treat strokes in children, including newborns and fetuses.

Baby Joey

An excerpt from a blog, Raising Arizona Kids, tells one story of thousands:

“Chandra Whitfield, of Mesa, learned just a few months ago that her son, Joey, suffered a stroke in-utero.

At first, Joey was an easy going, happy, typical baby, welcomed by his parents and brother Daniel (3 ½).

But at around 8 weeks, Chandra began noticing a few things about Joey that seemed different from her experience the first time around with Daniel. She mentioned her concerns to Joey’s pediatrician at the next well check.

The doctor diagnosed Joey with tortocollis, which can occur while a baby grows in the womb if the muscles or blood supply to the fetus’ neck become injured.

He prescribed some stretching exercises and suggested that Chandra put toys on on Joey’s left side to encourage him to turn his head. That helped, but at four months, Chandra begin to notice that Joey wasn’t reaching for toys with both hands- just his right hand. At his six month well check, he still didn’t seem to be using his left arm and hand – and Chandra decided to trust her ‘mommy gut’ feeling that something wasn’t right.

She asked the pediatrician for a referral to a pediatric neurologist, just to rule out that anything was seriously wrong. Finally, Chandra and her husband, Chris, received some tough news about their little boy.

Joey was diagnosed with left-sided hemiparesis (weakness on the left side of the body) due to a stroke in-utero. An MRI followed and confirmed the diagnosis.

Since the diagnosis, Chandra says she feels ‘as if a fire has been ignited in me.’ She began working to raise awareness about childhood stroke. She and her family have walked in the Stroke Walk, a fundraising event. She’s been selling purple awareness bracelets and donating the funds to the Children’s Hemiplegia and Stroke Association (CHASA), she’s got plans for a website, and volunteers for CHASA.

Chandra also sent a letter to Governor Jan Brewer requesting that May 7 be declared ‘Childhood Stroke Awareness Day.’ Here are Chandra and Joey on the day just a couple of weeks ago when they received the news that the request was granted, and more.

Chandra and Joey Whitfield

Arizona now joins several other states in declaring May as Childhood Stroke Awareness Month. CHASA hopes to build a grassroots effort to add more states to the list.

Joey is a year old now and doing well. He works with a physical and occupational therapist to help strengthen his left side. The testing and therapy will continue, but so will Chandra’s will to get the word out to others to raise awareness—and to grow a community. Because what Chandra says has helped the most is the connection she’s made with other parents of children who have suffered stroke in-utero.”

My God. Babies and strokes. It happens. And now you know.

I went to the local imaging center in May, a chain that specializes in mostly MRIs, CT scans, ultrasounds, and X-rays. The technician scanned my arm with an ultrasound and told me that I didn’t have clots. The doctor verified the result in a letter. But what no one told me was the technician went up too far and scanned my thyroid, too. A few weeks later, I got another letter, recommending a biopsy because my thyroid had eight nodules, seven of them too small to worry about. The eighth one gave the doctor concern. I made another appointment as soon as possible which translated into three weeks, but a little background first on cancer and biopsies. .

Nodule. Carcinoma. Tumor. Malignancy. Lesion. I call it the “C word.” But no matter what you call it, cancer is cancer. I thought I had it from all the X-rays and CT scans over the last three, stroke-related years. Today, after the smoking PSAs and warnings on the cigarette packs, and a lot of pink depicting Breast Cancer Awareness, more than a million cancer deaths have been avoided in two decades. Even so, there is still cancer.

The American Cancer Society says that cancer deaths in the U.S. continue to go down for lung, colon, breast, and prostate cancers, which are responsible for most cancer deaths. However, some of the less common cancers have been on the increase in the past decade, including pancreas, liver, kidney, and thyroid cancer.

A biopsy, a sample of tissue taken from the dubious site, is done in order to scrutinize it more carefully. Biopsies are done when an initial reading suggests an area of tissue looks suspicious on an imaging test, for example. Lest you think I am straying from the issue at hand, here’s the reality. Most often, biopsies are done to look for cancer.

So there I was, an uncomfortable stroke survivor, lying prone on a table and staring up at the ceiling, waiting for the biopsy to begin. I started to count the square tiles, count the lights, count the square tiles again. When the radiologist came into the examining room, as I was silently planning my funeral and after-party, the doctor showed me the needle (most commonly used on all biopsies) he would use to remove a small amount of thyroid tissue with the assistance of numbing medication and an ultrasound to identify the nodule.

“You will probably be sore after the biopsy, but the soreness should just last for a few days. Use an ice pack initially, 20 minutes on, 20 minutes off, and take Tylenol, and if the site becomes swollen and/or hot, you can call us at any time. A doctor is always on call,” the radiologist said. “There will be three samples taken, one at a time.” I started planning the inheritance for each of the kids.

The biopsy was over in a few minutes and I took a nap when I arrived home. The pain that would “last a few days” lasted a week, with the intensity getting weaker every day. Mostly, I had a sore throat.

The radiologist sent me a report of the findings in another two weeks, and all it said was “abnormal tissue.” The report also recommended a biopsy again in three months. So, of course, I wanted a second opinion. A doctor friend recommended an otolaryngologist who specialized in thyroids. So I went to see him. The “oto” recommended Veracyte, a thyroid testing company, that goes the extra mile to test the sample completely. The sample was sent to San Francisco where Veracyte is based, the land of the “Big One,” (referring to an earthquake forecast recently for the San Andreas fault that could end up being bigger than earthquake experts previously thought).

According to the Veracyte literature, the test “measures the amount of activity of 142 genes in the thyroid nodule…to be performed only when cytopathology (the examination of cells used to diagnose nodules) is indeterminate.” “Abnormal cells,” the diagnosis on the first report, was about to get a re-do.

Three months later, I went to get another biopsy, this time with four samples, and again one at a time. The biopsy, like the other one, took a few minutes. I knew the drill by now. Ice pack on and off, Tylenol, nap, and the sore throat for a week. The results letter arrived two weeks later. I was glad the “Big One” didn’t hit yet. The letter said that no evidence of cancer was found because the nodule was benign.

Look at all the time I wasted, worrying about thyroid cancer. Three weeks to the first biopsy, then three months to the second biopsy, and then two weeks longer for the results to come. I couldn’t get the time back, but once again, a lesson learned: Don’t worry until you know.

I think I need a root canal. No more delaying, I decided. I’m going in four months–tops.

Men basically have two things to worry about: erectile dysfunction and the prospect of prostrate cancer. Big deal. But most men don’t know what it takes to be a woman because they’ve never walked our mile. Permit me to elaborate: wearing a clumsy pad or a tampon that was pushed up too far while our 30+-year period continues to flow; achieving pregnancy with bipolar-ish hormones run through our veins; using itchy make-up, because it was the best buy, that was not tested on animals; losing our diaphragms somewhere, somehow, inside our bodies; experiencing the annual pap smear that will tell you if uterine cancer is in the cards; and, my personal favorite, getting a mammogram, especially after my stroke.

A mammogram is a bitch. Millions of women, including me, have to get a mammogram every year to detect, primarily, cancer and other breast disorders.

A mammography exam is a type of imaging that uses an x-ray, the low-dose type, to examine the breasts, called a mammogram, which is used to aid in the early detection and diagnosis of breast diseases in women. Other machines exist to capture the breasts’ images, but an x-ray is the most popular. If the doctor suspects a problem, you might use another method of scanning the breasts, like an ultrasound.

Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can detect lumps. Currently, many associations, like the American Cancer Society, the American Medical Association, the U.S. Department of Health and Human Services, and the American College of Radiology, recommend a mammography annually, starting at age 40, when women are most likely to receive the best form of treatment if any cancer is seen. Women who have had breast cancer at a younger age, or who have breast cancer in their genetic history, could have a mammogram sooner than 40, according to the National Cancer Institute.

Here’s where the rules come in.

–Your mammogram should not be given the week before your period, if you’re regular or not, when your breasts are sensitive. –If you suspect pregnancy, tell your doctor or x-ray technologist because your breasts may be too tender to handle.

–If the screening place is a new one, gather prior mammograms and make them available to the radiologist. If your screenings are done in the same place, the radiologists should have them there. Asking doesn’t hurt.

–Wearing deodorant, lotion, or powder on the day of your mammogram could show up as calcium spots, not a good thing, so risk smelling foul for one day.

–If you don’t hear from your doctor or the mammography site, don’t assume the best. Call after one week. Possibly, and likely, someone screwed up in informing you.

In the mammography process, a technologist will put your breasts, one at a time, on a platform, compressing them with a paddle, commonly made of clear Plexiglas. Compression is necessary to put the breasts flat, to spread out the breast tissues to scan as much of the breasts as possible, and to hold the breasts still while holding your breath to not make the pictures a good waste of time.

Breast implants can also make mammograms difficult to read because both silicone and saline implants are not transparent on x-rays. But trained technologists and radiologists know how to compress the breasts to make the view successful without rupturing the implant. (Squish? Just sayin’). Also, a small portion of mammograms show that cancer exists when it is really not there, known as a false-positive result.

The mammography is performed on an outpatient basis and it’s a 30-minute process, tops.

In my case, having a stroke didn’t have much to do with my mammogram except for one thing: my one breast hung down lower than the other because of my sub-luxed shoulder which happened from the stroke. In layman’s terms, the shoulder muscle was detached from what used to be the ball and socket configuration. So the scan was harder to accomplish. The customary views are right breast, top to bottom, and an angled view, and the same with the left breast. Though the technologist had a routine by always starting with the right best, she did the opposite.

“I’ll x-ray your left breast first, then the right. I’m breaking my routine since I always start with the right breast. But it’s going to be harder to x-ray the right. I’m a creature of habit. First right, then left. Right, left. Right, left. But on you? left, then right.”

Is there a phrase that’s stronger than “shut up?” F*%! you, maybe? I didn’t know how to deal with this “Chatty Cathy,” but I started to count. Counting always calms me.

The technologist squeezed my breasts with the compression paddle on each of the four views, and then walked behind a wall while each picture was being taken, not wanting to expose herself to radiation. I used all my restraint to avoid the obvious ouch, ooow, and a few choice words, saved for occasions like this one.

I was hurting after the mammogram, while the technologist spoke again after she was finished.

“I want to see if the pictures came out. I’ll be back. And I want to see if the sides are labeled correctly. I usually start with the right, but in your case, I started with the left breast, saving the worst for last.”

That’s the second time she said that she usually started with the right. And the worst? For last? The technologist didn’t know when enough was enough.

I was all finished dressing myself when the technologist returned and said the pictures were fine.

“I see you’ve dressed yourself before you knew whether I’d have to re-take one of the images. You must be in a hurry to leave.”

I was going to say something, but in the scheme of things, fighting the really tough battles, this wasn’t one of them. I only smiled. And I’m proud of myself. For once, I knew when to shut my mouth, not to say something I would regret later. But if I had to repeat the scan, I wouldn’t know what I’d do. Jab her with my cane? Maybe. But everybody forgives a stroke survivor. Heh, heh.

About two weeks later, I received a letter from the place that did my mammogram. It said, once again, that my mammogram was normal which made me happy, until next year when I’d go through “the squeeze” again. Sigh.

Photo credit: Raukus

By now, so many months later, I’ve heard mostly everything that has been said about strokes, including upsetting rumors, dreadful untruths, and uplifting myths. Let’s take these issues one at a time. The comments in parentheses are mine. I’ll give you examples, too, even though it’s sort of painful to do so. But, hey. I’m here to teach you about strokes, so I’m obligated. But it’s so hard to hear that stuff, from people who just don’t know.

Upsetting rumors

When I was at Rehab X, I overheard (yes, I was eavesdropping) two stroke patients conversing.
“Could I get worse than this?”
“Sure. I heard from a nurse that sometimes, a stroke can turn into measles.” (Measles come from a virus. The nurse doesn’t know jack! The scary thing is, why doesn’t she know?)

Or this one, heard from a CNA:
“If you don’t brush your hair regularly, you’ll lose most of it.” (Hair loss comes about for many different reasons, and one of them is trauma. If you’re “out of the woods” as far as strokes are concerned, most likely your hair will grow back).

Dreadful untruths

Untruth: A stroke survivor who was giving a talk said, “Stroke patients die more often than not.”
Truth: Nope. They don’t. (In fact, the ratio is 5 to 1, that is, people who live as opposed to people who die from a stroke).

Untruth: Heard from a doctor, “Stroke victims are likely to be depressed for at least five years.”
Truth: I thought of suicide, and here I am, alive. (It’s more accurate to say, “Stroke victims have those days where everything seems to be going wrong. But doesn’t everybody?”)

Uplifting myths

A physiatrist once told me, “You were a piano player before your stroke? Well then, if your hands are stretched already, you’ll be playing soon.” (Yeah, right!)

Or this one from a therapist: “You have a lot of dexterity in your fingers. You’ll be OK.” (The therapist gave me hope–false hopes).

Of course, all this stroke talk about rumors, untruths, and myths prompts the question, how much do you really know about strokes? I want you to take a quiz on strokes, brought to you, in part, by the University of Virginia, and the other part by me, if you’re up to it. You may be having a bad hair day, so come back and take the quiz later. But promise me you’ll take it, sooner than later. Cover the answers with paper and then reveal them one at a time to see how well you did on the quiz. Or you can cheat. Whatever. Either way, I hope you’ll remember what this quiz is telling you. Here goes:

1. Which of the following is NOT a stroke symptom?

A. Sudden weakness, numbness or inability to move a body part
B. Sudden blurred or fuzzy vision
C. Sudden very painful headache
D. Sudden crushing pain in the chest
E. Sudden inability to talk or understand others
F. Sudden dizziness or loss of balance

D is the correct answer. Sudden crushing pain in the chest is a sign of a heart attack (or indigestion), not of a stroke.

2. A stroke usually comes on gradually.
A. True
B. False

B is the correct answer. A stroke is sudden, and if you’re convulsing and go into a coma, as I was, then you’ll find out later.

3. If you or someone else experiences any of these stroke symptoms, what should you do first?

A. Call 9-1-1.
B. Call your family doctor.
C. Call a family member or someone else who can help.
D. Take an aspirin and lie down.

A is the correct answer. Calling 911 brings the rescue squad. Once they arrive and you are on your way to the hospital, if need be, you can call your doctor or a family member. Don’t take an aspirin, because it can make some types of strokes, like a hemorrhagic stroke, worse. And though this wasn’t one possible answer, don’t attempt to drive yourself to the ER or take someone there. Paramedics and EMTs are trained to assess strokes and can telephone or radio hospital staff that you’re on your way. Do you want to drive and be called a doofus for the rest of your life?

4. If you aren’t sure whether you are having a stroke:

A. Call 9-1-1.
B. Call your family doctor.
C. Take an aspirin and lie down.
D. Call a family member or someone else who can help.

Same answer–911. Same response on doofus, too.

5. It is important that you call 9-1-1 immediately if you have stroke symptoms because:

A. You cannot be given “clot-busting” drugs more than 3 hours after symptoms begin.
B. A bleed in the brain may require immediate surgery.
C. The hospital will know you are coming and be ready for you as soon as you arrive.
D. The earlier you are treated, the more likely you are to improve.
E. All of the above

E is the correct answer. When the rescue squad arrives, the EMTs and paramedics will assess your status. Then they can let the ER know you are on your way and the doctors can be prepared to give you tests to learn whether you are having a stroke. If you are, they may be able to give you a “clot-busting” drug if the symptoms began less than 3 hours earlier. If you’re bleeding in your brain, a neurosurgeon may want to operate right away. If you’re having a stroke, and you didn’t go to medical school, let the doctors do their thing. You have no choice.

6. Which of the following is true?

A. “Clot-busting” drugs can help strokes.
B. A stroke caused by bleeding requires immediate attention by a neurosurgeon.
C. Stroke symptoms are almost always reversible.
D. Doctors can’t do much to cure a stroke.
E. A and B

E is the correct answer. Stroke symptoms often can be minimized if you are able to receive “clot-busting” drugs. If you are bleeding into your brain, you may need emergency neurosurgery. The sooner, the better when it comes to stroke patients.

7. It is best to receive treatment at a hospital that offers: Clot-busting drugs, Neurosurgery, a 24-hour-a-day “stroke team”, a neuro-intensive care unit, and a wing that specializes in caring for stroke patients.

A. True
B. False

A is the correct answer. All of the above-listed elements are necessary.

8. To prevent a stroke:

A. Take your blood pressure medicine.
B. Stop smoking.
C. Eat foods low in fat and salt.
D. Get screened for blood pressure, diabetes and cholesterol.
E. A, B, and D
F. All of the above

F is the correct answer. They are all important to preventing stroke. So come on. Get with the program!

9. Doing everything you can to prevent a stroke will also help you prevent or control:

A. Heart disease
B. Diabetes
C. Some types of cancer
D. Liver disease
E. A and B
F. All of the above

F is the correct answer. A healthy lifestyle will help you control or prevent all of the above–and more!

10. How do you speak to a stroke patient?

A. By speaking loudly
B. By speaking softly
C. By speaking slowly
D. None of the above
E. All of the above

D is the correct answer. Unless the stroke survivor has a hearing problem or a cognitive disorder, speak as if you were speaking to anyone else. Check out my post entitled, “The Top Ten Things You Should Never Say or Do to a Stroke Patient–5/17/11.” Really.

I’m not going to ask how you did on the quiz, but if you didn’t get a perfect score, take it over again. If you did get a perfect score, take the quiz over again anyway. Damn it. You owe it to yourself.

It’s so hard not to stare
At that honky tonk badonkadonk
Keepin’ perfect rhythm
Make ya wanna swing along
Got it goin’ on
Like Donkey Kong
And whoo-wee
Shut my mouth, slap your grandma
There outta be a law
Get the Sheriff on the phone
Lord have mercy, how’d she even get them britches on
That honky tonk badonkadonk

So when crazy-as-a-loon, slap-your-grandma, meant-to-do-it Trace tweeted a picture of himself wearing a hospital gown when getting his kidney stones blasted (tweets are generated by Twitter for all of you who know how to get on Facebook and not much else), the hospital gown had its back open, allowing you to see Trace’s bootie. His comment in the tweet was, “@ Vanderbilt having kidneys stones busted. No big deal.”

The big question is, why would he do that, being an icon and all. And why would anyone want to see Trace Adkins’ flat, skinny, sorry ass? I saw it and it wasn’t pretty. Not even close. (You can see it, too, if you want, at this link: tasteofcountry.com/trace-adkins-naked-butt-surgery-twitter/). Some history follows on the hospital gown, and then I’ll tell you my experience with the gown. Unlike Trace, I didn’t mean to show “it.”

The hospital gown has been in use since the beginning of the 20th century. There’s been some adjustments–a snap or two, cloth straps vs plastic ties–but mostly, they’re still the same. I don’t get it. The gown is the premier piece of clothing that separates the patients from the visitors and staff. So why no improvements?

“It is amazing. We have created a product nobody likes,” says Blanton Godfrey, dean of the College of Textiles of North Carolina State University and an advocate for change.

That’s right. Almost nobody likes the hospital gowns. But the college went ahead and established focus groups to hone in on the gowns. With hospital gowns now holding over a whopping $75 million in the marketplace, somebody had to do something. And they did. The college got a grant, a quarter of a million to be exact, to improve the design, production, and marketing of the gown. A muckety-muck, the program officer in charge, dubbed the effort “Down With The Gown,” that might be good for Trace Adkins’ mindset because he only wore half of it. Personally, I think they should have called it what it was: “That Dumb-Ass Gown Has to Go.” .

There were efforts to improve the open-air gown. Nicole Miller, the posh designer, came up with new designs, sporting stethoscopes, syringes and other medical-related stuff, for Hackensack University Medical Center (HUMC) in Hackensack, N.J., but in the ten years she has been re-inventing the hospital gown, HUMC is her only client. Maybe it’s because the gowns are double the price of the regular gowns.

At around the same time Nicole was performing her magic, trying to make something ugly into something not, Maine Medical Center in Portland came up with the sarong, an overdose of fabric for the Muslims patients, because they were missing appointments rather than wear the immodest hospital gowns. And designer Cynthia Rowley created gowns that were longer, had a mock turtleneck, and three-quarter-length snapped sleeves for women. She also designed a “gown” for men with expandable pants, a short sleeve shirt, and a matching robe. All improvements, for sure.

On the other hand, Michael Georgulis, the vice president of a nonprofit group which aligns 2100 American hospitals, thinks the old hospital gown has suffered an injustice. He says that there are two reasons the hospital gown should stay in its original form: the gowns are inexpensive and it works well in emergencies. Gregulis must have never suffered the indignity of the gowns. If he did have to wear the hospital gown, he might have sung a different tune. Seriously, how could he not?

So what happened to me? I’ll tell you because I want you to see how a stroke patient figured out what to do with the ass-inine gown. I broke my shoulder in the winter when I attempted to sit on a chair without arms. It was just a seat, but as I sat, I fell off because I lost my balance. I hit my head and hip, too, and passed out for a minute or two. I went to the hospital and, of course, the nurse put me in a gown, the unfancy, usual kind with a closed front and an open-air back. There were ties in the back, but as I walked to the bathroom in the busy emergency room, with one hand on the cane and the other hand not functioning, I had to make a run for it. Unlike Trace Adkins, I didn’t want anybody to see my behind as it flapped along, proverbially speaking, like two huge melons in synch.

I sat on the toilet and tried to imagine a better way. And then it hit me because, obviously, desperation (and necessity) is the mother of invention. I stood up and opened the door slightly to get a passing nurse’s attention. I said I wanted another hospital gown because mine tore at the straps. That was a lie, but with new hospital gown, I put it on backwards, the one underneath with the ties in the back, and the new one with the ties the front. My ass, at last, was secure.

I left the bathroom, knowing in full confidence, that my behind was safely tucked away beneath the new gown. I hadn’t come up with an idea that good since I discovered cut and paste back in the early 90s. When the doctor came in, he asked me why I was wearing two gowns.

“Because I don’t want my ass sticking out,” I replied. Then he saw the cane, chuckled, and put “2 and 2″ together. Two gowns indeed.

“Clever,” he muttered.

The doctor ordered an ultrasound and, as it turned out, I didn’t injure my partially-altered brain and I didn’t break my hip, but my shoulder was broken, and I still have swelling today, six months later, to prove it. But my bootie is right where it is supposed to be, unlike Trace’s, safely hidden away and not disappointing anyone.

It was in the beginning of the fourth week at Rehab X that I had a problem that I couldn’t surmount. It involved a CNA (no surprise there) and getting up in the middle of the night. Your first question would probably be, “What was I doing up in the middle of the night?”

But if you really thought about it for a nanosecond, you will probably come with the answer: I had to go to the bathroom, and that was because I kept hydrated all day, so afraid my “peeing” would stop working again. That was MY idea, but the doctor assured me that wasn’t the case. I didn’t wholeheartedly believe him and I was incurring another problem: skepticism.

I awakened at 3am, even with my headset, to the sound of snoring. At first, I couldn’t decide if the snoring bothered me more than getting up when all I wanted to do was sleep. But after one minute, I had no choice. I pushed the call button. A CNA arrived after about ten minutes. She was the CNA I had on most overnights when I awakened early in the morning. Her shift was 11pm to 7am.

“What the matter?” If she was studying my body language, she would already know. I had one leg crossed on top of the other.

I was still gesturing and pointing when I spoke. “I hafta go t’de bafroom.” But despite my restructuring of English language, she understood me.

“I’ll see if I can get somebody to help,” she said. And then she took off.

CNAs were a mixed bag. Some of them would take me to the bathroom by themselves and others called for help. I didn’t know what was the difference between those who would and those who wouldn’t, but I know now.

Nursing staff have among the highest back and shoulder injury rates of any occupational group. In many cases, nurses may experience the pain and suffering long-term, ruining their careers. So I didn’t fault the CNA to get help, but when she returned to my room, she was alone.

“I can’t find anybody, so let’s try to do it together.”

There were several things, using handy hindsight, that were wrong about that statement. First, was there no one to help her if she felt that help was needed? Second, I couldn’t help someone who was trying to lift me. I couldn’t even walk at that point, so “together” was out of the question. And third, what she mean by “try”? She helped me anyway, despite my feeling of gloom and doom.

And then she dropped me, just like that. I could feel the icy linoleum as I plummeted to the floor, flat on my side. And then the announcement came–too late, in my opinion.

“I’m pregnant.”

Why are you telling me this now, after the fact, I thought to myself. Although I could speak now, her actions rendered me speechless. She left my room in a hurry, and in about thirty seconds, returned with the RN. The two of them returned me to my wheelchair. A flutter of activity, meaning a few nurse types, began to assemble in the hallway. And I had one more question: Where were they before this accident happened? The CNA probably didn’t look hard enough, if she looked at all. I reminded them again of the bathroom.

They took me and I used it, but I wasn’t happy. If the CNA was pregnant and didn’t feel comfortable getting me in the wheelchair, she shouldn’t have tried. She could have asked the nursing crowd, which got even larger, congregated in the hallway. This place, Rehab X, was a mess.

The CNAs, the daytime shift, were back to take me for a hip X-ray, and everything turned out fine for Rehab X. Nothing was broken except my spirit. In my case, I had a bruise, actually a hematoma, on my hip that was, according to the globe I had at home, like the size of Russia. I was given an icepack that I had to use three times day for a week. But the second day, I only received the ice pack in the morning. And the third day, I didn’t receive it at all. I gave up asking.

That’s how Rehab X was, a hit-or-miss place. I wanted to get out of there. However, I would stay there for three more weeks, as it turned out. As much as I improved my mood at Rehab X up to that point, that accident set me back almost to the beginning of my stay. Just three more weeks, but the end of the tunnel was nowhere in sight.

Now for some trivia on a non-trivial topic: In England, voyeurism became a criminal offense in 2004, if the subject didn’t know he or she was being viewed. In Canada, voyeurism became a sexual offense in 2005 by the same guidelines as England. In the United States, voyeurism can be both a criminal and sexual offense, and may have the guilty party register on the Sex Offenders List.

And there’s more. In Saudi Arabia, the sale of camera phones was banned for about a year because of non-consensual pics but reversed in 2005 only because cellular companies wouldn’t be able to offer complete 3G services if camera phones weren’t included. In South Korea, the government requires that all camera phones elicit an audible noise whenever someone snaps a picture. In places like Afghanistan and Iran, voyeurism can lead to, well, who knows. The point is, voyeurism is annoying, to say the least.

Sorry to say, I had my own experience with a voyeur at the nursing home. The man was old and he was harmless but a voyeur, none the less. Here’s what happened.

One week had passed and I still didn’t get someone, probably a CNA, to shower me. The nurses didn’t say anything and I didn’t either. maybe because I realized how the Shower Room was used. Remember the post “WARNING: This Post Contains Language”? To repeat, the individual rooms didn’t have showers so the Shower Room was it, where anybody went if they urinated, pooped, or threw up on themselves. The Shower Room also was used, well, if you just wanted a shower. In other words, the Shower Room was for anybody for any reason.

After a week, smelling like anything rotten, I succumbed to taking a shower when the new CNA, one I hadn’t seen before, came into the room saying, “When’s the last time you had a shower?”

I replied with a shrug. I guess the word got out. I didn’t have a calendar and every day was just like every other day, for the most part.

I didn’t want to tell her it had been a week because I was dreading using the Shower Room. I was wearing a hospital gown (gown is a misnomer, right?) and she put me in the wheelchair. She covered me with a blanket for privacy, but she didn’t have to do that. My modesty was lost at Rehab X when I showered with a man (see the post called “A Shower with a Strange Man: It’s Not What You Think”). And off we went down the hall.

A very old man was sitting as close to the Shower Room as he could get, like a sentinel. In fact, we couldn’t get in unless he moved. The man figured to be in his late eighties.

“Are you still peeking?” the CNA asked the man.

Oh, no! I asked her to turn around and take me back to my room. She ignored me, the elderly man moved, and in we went. I had a potential voyeur who wanted to see the good stuff which wasn’t that good.

There were horrors awaiting me, both inside and outside. Once inside the Shower Room, the CNA removed the blanket and hospital gown. My eyes were peeled to the door in case the man opened it. I was moved from my wheelchair to a chair that had wheels that could be locked (so I couldn’t go splat on the floor). The chair could also get wet. When I was seated, the CNA unlocked the chair and pushed me over to the shower. She started the shower so it would get hot.

Another CNA entered the Shower Room. The first one said, “Oh, I forgot to wipe the chair down.”

Huh? Wipe it for germs? From urine? From poop? From vomit? She wasn’t getting that I could talk and understand now.

I said, in broken English, “You hafta wipe the chair!” I didn’t know if those were the rules or not, but I imagined they were. I stood up for myself, once again.

So the two of them transferred me back to the wheelchair which was now covered with the blanket, cleaned the shower chair by rubbing it all over with disinfectact, and put me back in it. The whole event was getting long.

When the water was hot, she wheeled me in and put me under the showerhead and it felt good. Suddenly, with no warning, the door opened again, this time with the elderly man. But the shower hid me from his view.

The CNA, not intending to make any more mistakes, like wiping down the chair, said, “Get out of here. You can’t come in here.” And the men left.

The other CNA was with me while the first one went out to report the incident. I don’t know what happened to the elderly voyeur, but I guess he was returned to his room. In Russia, that move would probably send him to Siberia. And in Afganistan and Iran, anyone want to take a guess? Anyone?

After the shower was over, the two CNAs dried me, put me in a fresh gown and used a clean blanket to cover me, and I went back to my room.

The elderly man, a voyeur, was still waiting for anybody to take a shower over the weeks I was still at Rehab Y. I know because I passed by the Shower Room many times. It was a game for him in the nursing home, but in the real world, he wouldn’t stand a chance.

Even though they had good intentions, in all fairness to me, some of them said and did things that were downright insulting, if I took the comments and body language personally. But I didn’t ever, for those people who took the time and came to visit me.

In all fairness to them, how could they know the right responses from the wrong. What it really comes down to is this: How do you speak to a stroke patient whose had her life turned around in a 180-degree spin?

I made a list of the top ten things you should never say or do to a stroke patient, and I, too, have been guilty of most of them before having my stroke when I visited stroke patients. So having set the record straight, here goes.

1. Saying good girl, good boy, good job

Those are phrases you should say to your pets when they are being rewarded with a “Pup-Peroni” or Doritos’ chips. If you say them to me, I am not really being a good “anything.” I’m just sayin’. IT’S SORT OF CONDESCENDING.

2. Talking loudly

People have a habit of speaking loudly to foreigners and the sick. Just because they are from somewhere else, speaking loudly to a foreigner will not help get your point across. There is no hearing problem involved. The same thing applies to me. HOW DOES SHOUTING HELP?

3. Talking slowly

Talking slowly to a foreigner might be an asset. But talking slowly to me makes me feel mentally disabled. How would YOU like it if someone said, “How — are — you — feeling — today?” If I could, (and I wasn’t able to then), I would have talked quickly in response, possibly making them change their way of speaking. I REPEAT–HOW WOULD YOU LIKE IT?

4. Making faces at me

Stroke patients are difficult to understand at times, but please don’t squint, or turn your mouth to one side, or wrinkle your nose at me. Just ask me to repeat my statement, and if you still can’t understand, ask the question in a different way. After all, you’re the one with a full brain! SO USE IT!

5. Talking over me

I mostly listen, but when I get up the courage to speak, let me do it. Don’t interrupt me in the middle. In other words, LET ME FINISH!

6. Completing your sentence

Some people find the right word choice instantly, but it takes me a few seconds more. So please stop trying to fill in the blank. WAIT! I’LL GET IT!

7. Giving me lists of things to do

If you give me a list five or more things to do, I’ll may miss one. My brain is going, but the parts that are dead…well, simple died and there’s no hope of getting them back. Did you ever hear that heavy drinkers lose brain cells and the cells won’t be replaced? Same thing. YOU HEAR THAT, HEAVY DRINKERS?

8. Ignoring me as if I’m invisible

Once in a while, at Rehab Y, I would see doctors on the outside. If I’m waiting at a new doctor’s office, for example, staring right at some person who’s in charge, the person invariably stares at my friend to find out what my friend wants, forcing me to shout and look like an idiot–which I am not. I shouted several times in person but even more on the phone. Some of the people just don’t listen and say their “shpiel” regardless if I object.  “FOR CHRISTSAKE, I HAD A F***ING STROKE. GIMME A BREAK!” (Sorry to all in the PC crowd).

9. Saying I’m not moving fast enough

Once in a while, people will say something to the effect, “Could I get by you?” and start moving before they even hear the answer. Their rhetorical question, because that’s what it really is, a few times cost me my balance. WHY ARE PEOPLE IN SUCH A HURRY IN THE NURSING HOME?

10. Hanging up on me

A lot of operators hang up on me. They are nameless and they take advantage of that fact. But it doesn’t help me. WHY WON’T THEY WAIT?

———-

Now that I’ve off-handedly offended most of you, remember–I said or did the same things myself to stroke patients because I never “walked in their shoes.” So now, do you feel better?

Author Joyce Hoffman

This no-talking situation was really starting to get to me, big time. I thought, What if I didn’t say another word for the rest of my life? What if I had to motion to things constantly and nobody paid attention? What if there was an emergency and I couldn’t call for help?

The what-if questions were making me anxious and depressed. I didn’t have one thought about what I should do. But then I realized something that shook my innards to the core. I was becoming invisible to others. And that feeling of invisibility, that I couldn’t go on this way forever, became my modus operandi to do something about it.

About three weeks into Rehab X, it was just about lunchtime and I had concluded my morning therapy. The Transport guy delivered me to my room and I nabbed a CNA to help me into bed. I was going to take a quick power nap before therapy would resume again. I could smell the food in the hallways but by this time, I had gotten used to not eating. I just applied another layer of Vaseline to my cracked lips–the same hand to squeeze the tube and apply it–when an LPN walked in unannounced.

“You must be so sick of not eating,” she remarked.

I couldn’t say anything, but I nodded my head in agreement. And she stood there as if wanting to chat. Waiting, as if wanting to spend time with me.

“You look like you could use some extra pillows.”

She left my room and returned with two pillows. Well, this was a nice gesture. It was the first time anybody thought of my needing anything without my gesturing for it. She arranged the pillows on my bed–one for my head and one to use as an armrest. And she sat down and told me what was going on in the world–I’m a news junkie, but I don’t know how she knew that–and a funny story about her daughter who found a bird, semi-nursed it back to health, and let it loose in the park.

She sat with me for about fifteen minutes and then got up, saying she was sorry she couldn’t sit longer. And then it happened, just like that.

“T-h-a-n-k y-o-u,” I said, albeit very slowly. I was talking, or so I imagined.

The nurse took an audible breath and said, “What did you say? It sounded like ‘thank you.’” I had a witness so I nodded yes. I DID talk, didn’t I! Then she went out in the hallway to broadcast it to others.

Much later, I found out from the speech therapist what possibly happened. Not all types of aphasia, the lack of producing and/or comprehending speech, can be allocated to one type of syndrome. With my case, the syndrome that it would most likely approximate was Broca’s aphasia, the syndrome in which speech production was usually more severely affected than speech comprehension.

But she had another less academic theory. “I didn’t read this anywhere, but maybe what happened is you were so relaxed that speech, unsolicited, came out of you.” I could buy that explanation. It sounded so common sensical. And I had the extra pillows to prove it.

Quite frankly, I didn’t care what the theory was. I was talking, and it wasn’t long until I said what was on my mind. The words weren’t pretty, but they were honest.

Author Joyce Hoffman

After the gift basket lady from Rehab X left me with stroke-related and other assorted take-aways, a Certified Nursing Assistant (CNA), which had her name and her title right on her tag, helped me into bed because I couldn’t help myself. She left right away and, it seemed, she couldn’t get away fast enough. I wondered, does everybody treat stroke patients this way? Not even a “hi, how are you?” or “what good weather we’re having.” The CNA offered nothing.

I didn’t know what a CNA was, but I found out soon enough. They were the people who give showers, brushed hair and teeth, cleaned up urine and poop, helped with the meals, and a couple of other activities, in no particular order.

It soon became obvious: there were not enough CNAs at Rehab X to go around, or they were hiding and didn’t want to be found. If I had to guess, the typical CNA was overworked and underpaid, so I think they were hiding. There were about five places a CNA could hide and not be found for much of the day.

How do I know? To everyone else but a select few, I appeared to be a non-talker, which I was, and a non-thinker. But I was thinking all the time, and it was sort of like being in disguise. They couldn’t see my brain clicking or watch the smoke coming from my ears, as the cliches went. And that was one of the ways I got by–fooling the CNAs, on the one hand, by being mostly brainless, and, on the other, observing everything, even things I didn’t want to see.

For example, when people would wheel me around, I soon came to know where the CNAs had the opportunity to congregate without being seen. And I even saw a few CNAs in one of the rooms that were hiding from the main thoroughfare, as many as four times in a single day, not counting lunch. Not every day or all the time, but the place was ripe for the ultimate hangout.

The other element to the CNA’s job which I detested was they wouldn’t let you do anything. I don’t mean risky ventures, like getting off the toilet and into your bed, but simple things, like brushing your teeth, doing your hair, or moisturizing your face. The reason? They all said, “We don’t have time.” And if some of them let me do those things at first, it wouldn’t take long for them to commandeer my toothbrush, hairbrush, and moisturizer, and do the tasks themselves.

That process, for me, was a wasted opportunity in training, getting me back to my regular routine. If anybody would know, it was me, having been a corporate and technology trainer for twenty years. But they didn’t know that, and as much as I would have liked to tell them, I didn’t because I couldn’t speak, as much as I was itching to do it.

It was soon evident to me that I was only a body, not a person, in the CNA’s eyes. I was the prototypical eighty-five-year old. Everybody was treated the same.

Another thing I would do to get by was I screamed sometimes, and when anybody heard it–an RN, an LPN, or even a CNA (if they were available and not hiding)–they rushed into my room. I said it was coming from across the hall.

I didn’t like the deception, but it kept me from going crazy.

Author Joyce Hoffman

[Editor's note: This article is second in the series, The Tales of a Stroke Patient. You can access the other articles here.]

I was still thinking, a week later, of the nurse who told me about her infant sister who had a stroke. There was something about that story.

Anyway, I made it through the weekend, continuing with the Lovenox. The headache would come shortly.

It was Monday, April 6. I worked all day Monday with some pain still in my legs, training the new people who came to the firm, and worked on Tuesday as well. I wanted to save my days for a vacation, a vacation that would never come.

Tuesday evening, when I was ready to leave work, my manager wanted to know if I could stop by and have dinner with the Information Services people from the Applications group. Applications was planning an upgrade and there was so much food, she said. I agreed. But if I knew that the stroke would be ravaging my body in about ten hours, I would probably have elected to go shopping instead. That’s the thing about choices. Sometimes you just don’t know.

The party was Mexican fare and I went back for seconds. I felt good hanging out with those people, the camaraderie they provided, and the distraction from the pain in my legs. I was suddenly in no rush to go home, but I had the beginnings of a headache. I could count on one hand how many times I’ve had headaches in the past twenty-five years. And they were all due to sinuses.

I started to wonder. Did I have a good day? Yes, I did. Check! Did I have lunch? Yes. Check! Did I have enough water to drink? Yes, again. Check! I left the office and headed straight for the car.

The headache had grown stronger. I decided to go to my friend’s house in New Jersey. I didn’t know where this headache was going, but if it got worse, at least I would have my friend there to help me. Plus, I would watch American Idol to take my mind off the headache. It was a perfect plan.

My friend retired about 9:30 pm and AI didn’t make my headache go away one bit. It got worse. My friend was already asleep, but I woke him anyway. I told him about my headache, and he went and got me Tylenol. Somehow, after awhile, I fell asleep.

And that was all I knew. I went into convulsions about 4:30 am. I missed the paramedics who came to my friend’s house, the hospital–the same hospital where I went for my blood clots–where I spent fifteen hours under observation, and the helicopter flight to Capital Health in Trenton, known for treating severe neurological problems.

And that’s what I heard first from my son: “You’ve had a stroke.” My son? He was in Pittsburgh. So what was he doing here? I was so confused. And then that quickly, I forgot that thought and fell back into a deep sleep. Sleep was what I wanted even though I had been in a coma for eight days.

Author Joyce Hoffman

[Editor's note: This article is second in the series, The Tales of a Stroke Patient. You can access the other articles here.]

I went to the closest hospital on Sunday before noon, and now it was Monday, 1:30 am. I was still in the ER. A room was finally available. The nurse assigned to my care told me the story about her sister who developed a stroke when she was an infant.

I don’t know why she told me that story. It was, after all, the middle of the night, and I was tired. But she was trying to prepare me, and I didn’t get it. A stroke wasn’t in my frame of reference. Not at all.

During the next two days, I was given more blood tests, but the tests were few and far between. So I just laid in the hospital bed watching television. The nurse would come in and ask me if I wanted anything, and I started to feel like I was on vacation. I continued not to get it.

At one point, a hematologist, assigned by the hospital, put me on Lovenox, an injectable blood thinner, for thirty days, at a twice-a-day dose totaling 160 mg, to break up the clots. I received instructions from the nurse on how the needle worked. Also, I was still dangerously low in my platelet count. The doctor thought I needed to address both the clots and low platelets and said to follow up with a hematologist in Philadelphia.

On April 1, the hospital released me and I drove myself home. On the way, I picked up the Lovenox at the pharmacy. I also stopped for Chinese comfort food as a distraction from the pain which was still there and constant.

Over the next two days, I saw an improvement in the pain level (or I wanted to believe the pain was decreased via the power of suggestion). On the afternoon of the second day, I found a hematologist in Philadelphia. When my blood was assessed while I was still in his office, my platelet count was still low, though he agreed with the dose and the length of time for the Lovenox.

I thought to myself, in an optimistic way, the clots would go away, and I had narrowly escaped something that would throw my life is disarray. Besides, this wasn’t a good time to miss work, with events coming up, one after the other. It’s never a good time to miss work. Never when you love it.

But I wouldn’t have the thirty days of Lovenox after all. The stroke was only five days away.

The beginning of the drama and I couldn't stop it.

[Editor's note: This article is first in the series, The Tales of a Stroke Patient. You can access the other articles here.]

I can’t really say what happened when I had my stroke on April 8, 2009, because I was unconscious for eight days after. But I can tell you about some events before, like the pain in my legs beginning on March 26, 2009, and my unbearable headache the night before the episode that would change my life forever.

But a stroke was the furthest thing from my mind. It was something that happened to other people, meaning not me, which leads me to believe, if I could have a stroke, anybody could have a stroke. I’ll begin just before events started to become alarming.

It was in late March when I got into the elevator as I left the law firm in Philadelphia, staggering to my car a half block away from severe pain in my heels, feet and ankles. I was employed at Cozen O’Connor as a Technical Trainer, and though I didn’t mind at all standing on my feet throughout the day, I was so aware of it now.

My home was near Philadelphia, but I had plans with my friend in New Jersey. I had two adult sons, but they were seven hours away, and if I needed any sort of help, I could rely on my friend to give it.

When I arrived at my friend’s home, my pain hadn’t subsided and realized if the pain continued Friday, I couldn’t go to work. As much as I loved work, and as busy as I was, I couldn’t tolerate standing.

When I woke Friday morning, the pain was not the same. It was worse. Also, I had ear surgery two weeks before, and the doctor put me a round of antibiotics. I called the doctor and he didn’t know how the surgery could cause the pain in my legs, either. So I continued to take the antibiotics. At that point, I didn’t care.

My friend had to work both Saturday and Sunday and he left at 6:30 am. I was on my own. I called a friend of ours, an Orthopedic Surgeon, and these were his words to me: “If a warm bath doesn’t help and if the pain increases and moves up your leg on Sunday, go to the Emergency Room.”

All of the above happened and I was scared. I drove myself to the ER on Sunday. After an ultrasound and blood testing, the ER doctor saw blood clots. My platelets had also dropped dangerously low, unlike the ear surgery two weeks before when my platelets were normal. That was the beginning of the drama and I couldn’t stop it.

The doctor ran my platelets again and I was admitted. The stroke was 10 days away.

The 27-year-old analysis, including 28 studies of more than 300,000 people, determined there were 8,478 strokes. Depressed people were 45% more likely to experience any type of stroke than those who were not depressed. They were also at 55% increased risk for dying from that stroke.

We have Netflix, and it’s especially useful in the winter when there’s no point in taking a trek outside. I watched “Whose Life Is It Anyway?” last week, sort of knowing what it was about but not realizing the impact it would have on me. (Seriously, I should have known).

The 1980s film features Richard Dreyfuss as sculptor Ken Harrison, who became a quadriplegic after a car accident, and who’s hell-bent on the right to end his life. Also featured are Bob Balaban as a lawyer who helps Harrison achieve his wish for death by stopping the dialysis and being discharged, John Cassavetes as Dr. Emerson, who is determined to keep his patient alive even against Harrison’s wishes, and Christine Lahti as Clare Scott, a doctor who falls in love with Harrison.

The pros and cons of watching this film: On the pro side, you have to see it because this film is so powerful, it grabs you and doesn’t let go right away. On the con side, you shouldn’t see it if you suspect any kind of depressive disorder. No kidding. I didn’t just cry; I sobbed and bawled. But do I have depression? Maybe. Maybe not.

One study from Washington School of Medicine says that almost 20 million American adults, or 10 percent of the U.S. population age 18 and older, have some sort of a depressive malady. Does that high number surprise you? Really, it shouldn’t surprise you at all. The study was taken from doctors who have patients with depression. But some of the people who have depression don’t even recognize it. And some of them think they’re suffering from something, but they don’t know what. Only when they’re told it’s depression, if they seek the information at all, do they know.

Depression isn’t just “the blues.” Depression can cause emotional symptoms such as anxiety, irritability, and hopelessness. But it can also cause physical symptoms such as chest pain, nauseated feelings, dizziness, sleeping problems, muscle pain, changes in weight and appetite, and exhaustion. In a majority of cases, depression doesn’t have one cause. Rather, it’s a result from a lot of things, like genes, events in your past, your present circumstances. Most important, depression isn’t a flaw in your character and it isn’t your fault.

A recent study sponsored by the World Health Organization found depression to be a leading cause of disability in the United States. When it comes to me, not able to do much with one functioning hand, my friend has to do it all–go food shopping, take out the trash, deal with my anxiety. It’s a complete role reversal. That scenario alone is depressing. Sometimes, I think he’s depressed. But he laughs a lot and doesn’t have any of the classic symptoms like:

• fatigue and a decreased energy level (he’s never tired unless he’s watching television and falls asleep)
• feelings of worthlessness (he has such a huge ego)
• difficulty concentrating or remembering details (he doesn’t miss a trick, even when I want him to)
• excessive sleeping (he gets up at 6:15 every morning unless he has to teach when he wakes up at 5:15)
• overeating or appetite loss (he eats a steady diet because he’s a creature of habit)
• thoughts of suicide or suicide attempts (never)

Here’s a sketchy background on the most common types of depression which comes in many unwanted “flavors.”

According to the National Institute of Mental Health, clinical depression, also known as major depression, is characterized by a combination of symptoms that can interfere with a person’s ability to sleep, work, study, eat, and enjoy activities that are pleasurable. It can prevent you from functioning normally. An episode of clinical depression may occur only once or it recurs throughout a person’s life.

In addition, with clinical depression, one of the symptoms is either depressed mood or loss of interest. The ongoing symptoms should be present daily or nearly daily for at least two weeks. The symptoms cannot be due to the direct effects of a substance (medications or drug abuse), a medical condition, such as hypothyroidism, and not occur within two months of the loss of someone you cared about.

Chronic depression, or dysthymia, is characterized by a depressed mood of two years or longer. Chronic depression is less severe than major depression and typically does not disable the person. It tends to be identified by a consuming sadness.

Bipolar disorder, sometimes called manic depression, is a complex mood disorder that alternates between times of extreme excitement or mania and periods of clinical depression. In common vernacular, it is called “highs and lows.”

Seasonal depression, often called seasonal affective disorder or SAD, occurs each year at the same time. It usually starts in the fall or winter and ends in spring or early summer. It is more than just “cabin fever.” Another type of SAD, known as “summer depression,” begins in late spring or early summer and ends in fall.

Many factors can lead to depression including:

• Biological (with a chemical imbalance in the brain)
• Gender (women maybe from hormonal imbalances due to menstruation, pregnancy, and menopause)
• Medications (from side effects)
• Genetic (if depression is in your family, it increases the risk)
• Situational (Events like divorce, financial problems, or death of family or friend)
• Cognitive (negative thinking and low self-esteem ups the risk)
• Age (the older you are, the more likely)

See how the statistic of almost 20,000 people goes even higher? Even more, you may have depression or develop it if you have:

• thyroid disease
• cancer
• central nervous system disorders
• head trauma
• diabetes
• Alzheimers
• multiple sclerosis
• syphilis
• rheumatoid arthritis
• asthma
• kidney disease
• liver disease
• heart problems
• stroke

And of course, with those illnesses, even higher still. So statistics are a guesstimate. That’s all they are.

Now, here’s where I come in. So what’s the connection between stroke and depression? It isn’t what I thought. You don’t necessarily get depression after your stroke. You can get a stroke if you have depression. How about that?

In a piece written for the Journal of the American Medical Association, the new research shows that depression may actually increase risk of stroke and of dying from that stroke.

“We didn’t know whether depression, per se, could increase the risk of stroke, but now we have conclusive and compelling evidence that it can,” says study researcher An Pan, PhD, research scientist at the Harvard School of Public Health in Boston.

“Depression affects the quality of life, heart disease, and stroke risk, [and] is prevalent and is probably underdetected and undertreated. So this is another reason to think about monitoring people for depression and getting them the proper treatment,” says Ralph Sacco, MD, the immediate past president of the American Heart Association.

The 27-year-old analysis, including 28 studies of more than 300,000 people, determined there were 8,478 strokes. Depressed people were 45% more likely to experience any type of stroke than those who were not depressed. They were also at 55% increased risk for dying from that stroke.

So how does that stroke-depression connection happen. A few theories are credible. It may be that people who are depressed:

• don’t take care of themselves. They tend to get less exercise, eat less healthfully, and take part in unhealthy behaviors like smoking cigarettes.
• are also less likely to take their prescribed medication, like blood pressure or cholesterol-lowering drugs which, if present, are both possible factors for a stroke.
• have the same inflammation indicators in the blood that could set the path for a stroke.

So how do I see myself? I don’t really know. That mystery ranks right up there with the Bermuda Triangle and the Jimmy Hoffa burial site. Maybe I was depressed then, after I had my stroke, but I haven’t thought about Jack Kovorkian, the death master of patient-assisted suicides, for at least a year. But I can tell you this. I make an effort to laugh (supposedly the best medicine) at least once a day. You decide.