Stroke Life Society

"United In Pursuit Of Living And Helping Others"

"Ask The Specialist"

This page posts questions that arise in our support groups that we feel may be of interest to others.  

 

The "Specialist" can be a doctor or other professional qualified to answer specific questions. 

A "Specialist" may also be a fellow stroke survivor or co-survivor. 

 

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Question #29:
Re: Recovery

Q   2 months ago my mother, age 78, had a very severe stroke. She went to Jamaica Hospital in Queens. This happened a night after she had a suspected TIA and was released from the same hospital; she just walked out in the afternoon, and had to go back that night, and she could not walk or move her arm.

After spending some time in the stroke unit she was transferred to Trump Pavilion where she has been undergoing rehab therapy since that time. I am afraid that there has not been much improvement. Her left arm is still without movement, and all she can do with her lower left extremity is flex her foot slightly.

After 8 weeks, with very slow progress, and not much improvement, what do you think the chances are of her ever regaining some of her movement in her arm or leg? At her age, I am sure that they cannot be so aggressive with her therapy, and it makes it difficult to help her improve, assuming the stroke wasn't so bad in the first place that she can have improvement.

Question #28:
Re: Leg Pain

Q More than seven years after a stroke which left me both slightly aphasic and with right-sided weakness, a  series of 3-monthly Botox injections gave me greater mobility and improved use of my right hand. I no longer have access to the same Botox provider, and three years' later, the injections don't seem to be as successful. In addition, I am experiencing so much pain in my right leg that sometimes it is almost impossible to move around; the pain is often accompanied by swelling of the leg. Would a return to my original provider reverse this problem or do you think there is another cause?

Question #27:
Re: End of the Road for Aspirin?
Q:  I have read a recent report that although aspirin has been used for years to help protect patients from strokes, mounting evidence suggests the drug's benefits are too small compared with other treatments and although daily aspirin might still be beneficial for some patients, most – especially those with atrial fibrillation - should be offered something else as well or instead. Does this mean that stroke patients can expect to be put on a non-aspirin regimen in future?
Question #26:
Re: Numbness

Q:  I experience ongoing numbness. My right hand has not lost any strength or dexterity, but feels constantly as if I am wearing a glove. This feeling intensifies from time to time; mostly at night when I am resting or sleeping. The numbness on the right side of my face behaves in the same manner. My right shoulder sometimes feels heavy and slightly painful, but I do have full range of motion. Do other stroke survivors go through this and what, if anything, can be done to ease this discomfort. I consider myself fortunate that this is the maximum physical deficit that I have. Ninety-nine percent of the time     I have this “psychological damage” (I call it “shadows”) under control.

Question #25:
Re: Biofeedback, Neurofeedback and Robotics in Stroke Recovery

Q:  Part 1:  Please explain the comparative advantages of Biofeedback, Neurofeedback and Robotic therapies in the stroke rehab process.

Part 2:  What is Robotic therapy?  How does it work?  Is it freely available?  Does it hold hope for the improved usage of my right hand which, although strong, is still spastic after many years?  I have tried Botox treatment on the hand but the reduction in strength was unacceptable.

Question #24:

Re: Extended Rehab/Home Physical Therapy

Q: I have really benefited from the course of rehab I was given following my discharge from hospital after my stroke. My right arm and leg have been affected, but after treatment I am able to walk with assistance. I am so disappointed that the rehab has stopped right in the middle of this improvement – my insurance company has informed me that I was only eligible for a certain period. I’m an independent sort of person and I’m sure that with a little more treatment I could look after myself and move around the house. Is there an economic physical therapy provider in north-east Queens where I can take Access-A-Ride? Failing that, can you tell me if home physical therapy visits are available and if so would they be prohibitive in cost if my insurance will not pay for them?

[Several other members in Long Island have posed similar questions. –Ed]

Question #23:
Re: Hyperbaric Oxygen Therapy

Q: In a recent support group meeting, we had lively interest in hyperbaric oxygen therapy. What, if any, is its effectiveness in stroke recovery?

Question #22:
Re: Denial After Mild Stroke

Q: I am a 65-year-old widow and was diagnosed as having experienced a mild stroke two years’ ago. This left me with slight weakness in my right arm and leg. The deficit as my neurologist called it is so mild that I alone was conscious of it. My adult children considered the diagnosis to be a mistake and both they and my friends are still in disbelief such that I receive no sympathy or assistance from them with tasks I now find to be more difficult. Now that I have recently had a second mild stroke which has only slightly worsened my condition, my claims are met with denial and derision. Naturally I am anxious that I shall not suffer a more debilitating stroke in the future, but I fear that will be the only way to convince them. Short of this, what can I do to change the prevailing attitude of those around me? The whole situation has left me feeling a little depressed, disappointed and withdrawn.  

Question #21:
Re: Is There Post-Stroke Improvement After 18 Months?

Q: I am so very angry. As a first year stroke survivor, I am still confined to a wheelchair and my sight is affected so that I am legally blind. Will I be like this for the rest of my life? The doctors tell me that any improvement will have occurred within 12 – 18 months of the stroke and the insurance seems to agree as that source of funding is drying-up. Do you have a glimmer of hope to shine my way?

Question #20:
Re: Potassium and Salt in the Diet

Q What is the significance of salt and potassium in our diet and their role in reducing the incidence of stroke?

Question #19:
Re: Foot Drop Solutions/ Toe Curl Exercises

Q  Botox failed to tackle the difficulties I now encounter with my left leg. The toes are severely curled and I have foot drop. What is the experience of other survivors who are faced with this twofold problem? Are there treatments and exercises tailored to these conditions?

Question #18:
Re: Finger Stimulation Glove - Can it improve Digital Dexterity?

Q:  I now have improved use of my right hand following Botox treatment, and wonder if further improved digital dexterity could be obtained from new technology. I recently read of a finger-stimulating glove which can even prompt the wearer into playing the piano.

Question #17:
Re: Ticking TIA Time Bomb

Q: A questioner considers that given the frequency of her TIAs she is a time bomb ticking. She sets the scenario for her bifurcated question as follows:

I do not know where to start but I just had my 4th TIA and this was more serious than all of the others. The left side of my face went numb and it lasted about 50 minutes. I usually have a TIA once a year, but this one was only three months after the third. It is so frustrating that no cause can be found. I am on aggranox now, but previously was on Plavix for three months and it obviously did not work. Tomorrow I see my cardiologist, and I have many questions for him. Also, it is very frustrating that a lot of doctors think that I am lying or it is anxiety driving my condition. My mom witnessed the last episode as well as the paramedics and they took me more seriously; I was given heparin at the hospital and I am now on Aggrenox twice a day.


With regard to family history, my father did die of a stroke and heart attack, but he had high blood pressure, diabetes, and smoked for over 60 years; he also had circulatory problems. I am 47 years old and have a beautiful 16 year old. I really would like to prevent further TIA's. I never had high blood pressure, never smoked, drank or did drugs. I am about 30 pounds overweight - I lost 50 already and have 30 to go. I do have high cholesterol but the number went down after taking Pravachol. I try to exercise; I have been kickboxing for almost three years but have stopped - every time I plan on going back a health issue arises. Thank you so much. I wish that I had found this site sooner.

 

My question is twofold:

- Has Aggrenox proven to be successful in preventing more TIA's? I feel like a ticking time bomb because they said that the more I have the greater the chance of a full-blown stroke.

- Please explain about the cause of a TIA because of a hole in the heart which they haven't yet checked.

Question #16:
Re: Etanercept - A Miracle Cure?

Q: Etanercept seems to have great promise for post-stroke survivors.  What do you consider to be its efficacy in helping them restore lost functionality, reduce spasticity and improve cognitive impairments?

Question #15:
Re: TIAs, Migraine, Stress, and Full Stroke Onset

Q:  I have frequently suffered a number of symptoms which indicate the possibility of TIA’s or mini-strokes. Normally there is less than a 5-minute warning of the onset of some or all of the following:

-         Blurred Vision

-         Facial Droop

-         Left-sided Weakness. Sometimes the arm won’t work for 2 hours.

-         Aphasia. I know what I want to say but the words don’t come out fast enough.

This occurs at least once a week, lasts for a half-hour and can return 20 minutes later.

 

Various diagnoses, studies and treatments have occurred:

-         A small hole-in-the-heart, since repaired. (PFO closed arterially).

-         Confirmed migraine sufferer. Initially I took Imitrex, but no longer. This was followed by a blood thinner.

-         No seizures have occurred.

-         A 2-day study (continuous EEG) found nothing.

I now have frequent mini-episodes in which I stutter more, and I also suffer from memory problems.

 

Now for the question! I have been told that stress can cause a shut-down with physical symptoms similar to a stroke, but I am worried that in time these symptoms may no longer be transient. Could this situation develop into a full-blown stroke with permanent deficits and what treatments are available to prevent this happening?

Question #14:
Re: Disability Benefits

Q:  I suffered a stroke 5 months ago which left me weaker on the right side and affected my vision so that I have been advised by my doctor that I cannot drive. My employer will not allow me to return to work if I am not fit to drive, so I have lost my job. Would I be considered for disability benefit and if so is there a fast-track way to apply for it?

Question #13:
Re: Brain Stem Stroke, Guillain-Barre Syndrome and Dysarthria
Q: I was diagnosed with a stroke eight years’ ago, with a more recent repeat. On neither occasion did the ischemia show on MRIs. I have been left with bilateral weakness and require the use of a cane to help with balance. I have difficulty both in enunciation and swallowing owing to muscle paralysis in the mouth and throat. It can take me an hour to consume minced food which would normally take less than ten minutes. Numerous doctors diagnosed aphasia but I now understand that this may not be entirely the case for my fluency is unaffected. Is dysarthria the more probable description? Secondly, as the stroke was not evident on either occasion on MRIs, could it have been in the brain stem, could the problems have been caused by Guillain-Barré Syndrome, or even a combination of the two?
Question #12:
Re: Post Stroke Pain

Q: I have suffered from “central regional pain syndrome” since a stroke in December 2009. The pain is somewhat relieved by Oxycontin SR20 twice daily, along with Tylenol also twice a day. Of late the pain has worsened in intensity making it difficult to sleep at night even with the use of Lunesta. The pain is mainly in the affected left arm, however it can travel to the face, leg and back. Can you recommend a more efficacious treatment?

Question #11:
Re: Beneficial Effect of Chocolate

Q: I’ve been told that the risk of another stroke could be reduced by eating a quarter pound chocolate bar each week. Is this true? If so is it just dark chocolate or would milk chocolate also be beneficial?

99% cacao bars are available which contain no sugars. Do you think eating these would be compliant with my diabetic/weight reduction diet?

Question #10:
Re: Bruising

Q: I am concerned because since my stroke 18 months ago, I am always getting bruised. I know it‘s easy to fall and when I do, my arms and legs get bumps. My lower stomach has been getting bruised more easily these days and this is very concerning. I have not taken any blood thinners since I left the hospital. More recently my side is constantly sore. Are you able to throw any light on my problem?

Question #9:
Re:  Hearing Deficits and Stroke

Q: I am a stroke survivor since Feb 8, 2011. I have hearing loss in my left ear. It is pronounced when I’m on the phone or when someone is whispering in my left ear. My right ear is better except in crowds. In this situation, I still cannot hear and read lips as best I can. The audiologists have said I have passed my hearing tests and although there is more of a deficit with the left ear they don’t have a significant problem with my "hearing numbers". The latest audiologist is reluctantly giving me a hearing aid for the left ear. He really didn‘t want to prescribe it, however since I can‘t hear at all in that ear we will try it.

 

My neurologists tell me the apparent hearing loss is a function of my hemmoraghic stroke in the pons area, and maybe it will come back. What can I do to work the pathways to encourage hearing or neuron growth?

Question #8:
Re: Biofeedback Therapy

Q: I am a college professor on disability. I have a cardiac problem also one sided muscle weakness following a recent stroke. Biofeedback therapy has been recommended. Could you please tell me what this involves, how long does the treatment last, and do you even recommend this type of therapy following a stroke?

Question #7:
Re: Dizziness after stroke

Q: My 79 year old Mom had a mild stroke 2 1/2 years ago from which she made huge progress.  She experienced dizziness after it but that eventually went away. We were just told by her neurologist, after testing, that she experienced a stroke sometime since then, in the right portion of the pons (stem) and the right temporal lobe. She has been suffering with dizziness since last summer, which is why she went for the recent testing. The dizziness does not seem to let up despite attempts to change her meds. Is this common? Do you have other patients with a similar experience? Do you have any suggestions for her?

Q2: Also on the subject of dizziness, my grandpa recently experienced a stroke. It was about 3 months ago. He is now suffering symptoms similar to those which people with low blood pressure might have when getting up too fast. He gets dizzy and begins blacking out. He takes blood pressure medication as part of his therapy as well as aspirin. He feels as though it is low blood pressure but I was wondering what else it could be?

Question #6:
Re: Botox Treatment

Q: Following my stroke, I find myself with right-sided weakness which includes spasticity of both hand and foot. It is only with difficulty that my hand can be opened for hygiene purposes and walking is a real problem. Someone has suggested Botox treatment, and I'd like to receive advice from a stroke survivor who's undergone this treatment.

Question #5:
Re: Post-Stroke Depression

Q: I am surprised to see a marked variation in the depth of depression between myself and some other members of our stroke support group. Is it possible that different types of stroke spawn different depths of depression, or do those degrees of depression arise from our individual nature? As a 3-month survivor, will I find my depression naturally eases with time, remains the same or - heaven forbid - grows even worse? Finally, can you suggest any ways in which I can actively overcome this problem? 

Q: One follow-up question: Would you consider that the kind of "therapy" arrived at from peer (support) group meetings held by Stroke Life Society -  their sociability and the opportunity for discussion -  may also relieve depression? In our opinion, regular support sessions act as a diversion from total introspection and provide a ray of hope derived from the experience of others. Stroke is so isolating, and peer group sessions can act as an isolation relief valve.

Question #4:
Re: Triggers and Risk Factors

Q: I am 5’ 8” tall and weigh over 300 pounds. My wife keeps telling me to stop smoking and get off the couch to go for a walk as she thinks I’m unfit and I need some exercise. A friend of mine is a stroke survivor and he tells me I’m acquiring too many risk factors and could have a stroke; he also told me to watch out for triggers. What does he mean?

Question #3: 
Re: Risk of Repeat Strokes 

Q: I am a stroke survivor, but something has been preying on my mind since my first stroke a year ago:
- What is the risk of a second stroke?
- Are further strokes more likely in my situation?
- Does the risk decline through time?
- Is there anything I can do about it?
Getting rid of these nagging thoughts will certainly be conducive to a good night's sleep!

Question #2:
Re: Crying and Stroke

Q: I recently had a stroke and don't understand why I cry so frequently. Is this feeling common among stroke survivors? If so, why, and will the urge to become teary gradually diminish?

Question #1:
Re: TIA and Medication

Q: I am a stroke survivor, and recognized stroke symptoms, including one-sided weakness in my 45-year-old daughter. By the time she had arrived at the hospital, the symptoms had more or less disappeared and she was diagnosed with a TIA. In spite of (or possibly because of) my history of stroke, my daughter is in denial, and she claims to have been given no medication following her discharge, not even aspirin.

Is this usual, and do you think I am right to be worried about a second ‘mini’ stroke occurring if no medication is prescribed?

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