Dear Joyce: Unneeded Weight Gain For This Stroke Survivor During Pandemic

Dear Joyce,

As if life isn't bad enough, I gained 18 pounds during the pandemic because I'm going to the refrigerator more often than I should. I live in an apartment and the refrigerator is right there! The problem is, I had a stroke 6 years ago and, from being in so much, it was an unneeded gain.

I can't think of anything to do other than to stuff my face. I need some motivational advice because the 18 pounds makes my walking and talking sluggish.

Fatter in Frisco

Dear Fatter in Frisco,

Most people in my "bubble" gained weight during the pandemic. What did I do when I put on several pounds and then some? 

Try this, compliments of my son who adheres to it every day: I made myself a schedule. Every day from 6pm to around midnight, since most of the eating comes then, I have these "things" to do:

6-7: enjoy leisurely dinner and nothing after; 7-8: reading time; 8-930: writing time when I attempt my 3rd book; 930-1030: answer my email; 1030-11: watch political YouTube videos; 11-12ish: take my meds and bathroom stuff.

Only you can make a commitment to follow the schedule, but it works for me. You have nothing to lose but pounds! Let me know how it works for you. 

Why Do I Have Post Stroke Fatigue?

 This question was asked by me to the Strokefocus.net Forum and the answers come from my researching Post Stroke Fatigue. I believe you will find this information useful. So here goes:

Dear Me: 

I don’t want to take a nap. I need to take a nap. Why is that so?

Need, Not Want

Dear Need, Not Want:

In the world of acronyms, it’s called PSF, or Post-Stroke Fatigue. PSF is a given post-stroke. So what is the solution? Knowing that you need a nap, there are some suggestions on management. Follow along and track the 1) how 2) who, and 3) what respectively in these 3 recent studies.

The How

In the Chinese Journal of Physical Medicine and Rehabilitation, Yan et al wrote:

Issue: How you breathe makes a difference.

Findings: “Diaphragm training can significantly improve motor function and the daily life of stroke survivors. The mechanism may be related to improved respiratory function and decreased the severity of fatigue.”

Translated from medical jargon, that means you might take shorter naps, or even a 15-minute power nap, if you breathe the correct way. I took an armchair yoga class several times and each time, the instructor went over breathing: a count of 4 breaths in (inhalation), a count of 6 breaths out (exhalations). This breathing exercise is good for other things, like alone time for meditation and frustration moments. I try to do that breathing pattern all the time, and when I forget, I know, so I get right back on track.

The Who

In the Journal of Psychosomatic Research, Cumming et al discovered a couple of things, among others, that might interest you:

Issue: Confirmation of link between FMS (Functional Movement Systems) and disability and depression

Findings: "Post-stroke fatigue was associated with lower limb mobility, while post-stroke depressive symptoms were associated with cognitive performance."

Findings: "The current results underscore the importance of recognizing fatigue clinically, and the need to understand the underlying pathophysiology. Its importance is also highlighted by a high prevalence and persistence, remaining elevated in one study at 6-year follow-up." 

The What

In Lenus, The Irish Health Repository, Khan and Delargy found the following:

Issue: Rehabilitation can be severely affected by PSF

Findings: “Post-stroke fatigue is a frequently reported symptom by stroke survivors undergoing rehabilitation. This cross-sectional observational study was undertaken in a rehabilitation facility to look at its prevalence and relationship with various variables like personal factors, type of stroke, social context, hemispheric involvement on CT scan and mobility status. The results showed that PSF was present in 83% (25 out of 30) of the patients included in the study.”

Predictable, for sure. But when the medical researchers say it, you REALLY believe it. Please show this article to your family and friends if they say something negative like, “Get up already” or “Stop being lazy.” PSF is a real thing.

Brought to you by Strokefocus and one of its associations, Northwest Brain Network

Scared About Losing Part of Your Vision After Stroke

(This next request comes from the Strokefocus.net Forum. Though it wasn't addressed to me specifically, the answer  is useful and I believe I should share it).

Dear Joyce,

What can I do to improve my peripheral vision? I phoned my opthalmologist (who did my lens replacement some years ago) and was told nothing can be done. Is this correct? 

Scared About Losing Peripheral Vision

Dear Scared,

I suggest you read Dr. Heidi Moawad article. She is a neurologist and expert in the field of brain health and neurological disorders. The link is here: https://www.verywellhealth.com/loss-of-peripheral-vision-3146459

The bottom line? It is often common for a stroke to cause a visual field loss because the neural pathway between the eyes and the brain that clarifies what we see is a long one that can definitely be damaged by a stroke. 

Look for a second opinion, too. All doctors know different things but, as I say, no doctor knows everything. Perhaps there are exercises you can do to regain that loss.

Though loss of  peripheral may be permanent for some people, Dr. Moawad says, "A stroke that causes a loss of peripheral vision can improve over time as the stroke heals and stabilizes." 

We'll leave it on that very encouraging note! Write again if you regain some or all of your peripheral vision. We'd love to hear about your success. Best wishes!

Brought to you by Strokefocus and one of its associations, Northwest Brain Network

Hope for Stroke-Paralyzed Arm?

Dear Joyce,

What are the chances of my arm, that hasn’t move at all after a hemorrhagic stroke, getting better? I've been doing exercises on and off for 5 years and I occasionally fell for lack of balance.

I was told that I have a three-month window from the date I had the stroke for improvement to happen. Is that the standard now?

Concerned in Dallas

Dear Concerned,

Most occupational therapists who were recently trained starting about five years ago and later don't say that phrase anymore about windows for improvement. The reason? It's not necessarily true. 

Some people improve constantly whereas others, no matter what they do, improve slowly or, at some future point, stop improving. Putting a very narrow, spoken timeline for improvement is just harsh and takes away the motivation to improve. That's why a common saying is, Don't give up!

Falling in the biggest barrier for improvement. Aside from getting the initial shock, falling takes people back a step or two. Then people try again with a few days rest but, for example, they aren't where they were a month ago.

The most important thing you said: "I've been doing exercises on and off for 5 years." Keep doing the exercises that have been given to you constantly as long as you have zero chance of falling. Consistency will sometimes pay off! Or maybe you're at that point where improvement has stopped. 

If you have insurance, or can afford to pay out-of-pocket, see an Occupational Therapist (OT) another time. Maybe there are exercises you haven't tried yet. If it's possible, I found that a variety of OTs can have a different spin on the same function.

Time will tell.

Brought to you by Strokefocus and one of its associations, Northwest Brain Network